Individual
MR. KEVIN MICHAEL DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
303 S BROADWAY STE 200-135, DENVER, CO 80209-1558
(720) 401-2830
Mailing address
303 S BROADWAY STE 200-135, DENVER, CO 80209-1558
(720) 401-2830
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW09923147
CO
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578717211
—
CO
Enumeration date
11/07/2008
Last updated
12/29/2017
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