Provider Demographics
NPI:1619715778
Name:DAUGHERTY, AMANDA (MSW, CSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 APPEALS CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8679
Mailing Address - Country:US
Mailing Address - Phone:859-757-8932
Mailing Address - Fax:
Practice Address - Street 1:6900 HOUSTON RD STE 12
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4891
Practice Address - Country:US
Practice Address - Phone:310-619-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2557431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical