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KELLY DOUGHERTY LCSW
NPI 1023615614
Social Worker - Clinical in Bridgeport, CT

Active since October 06, 2020PECOS Enrolled
2625 PARK AVE UNIT 2J, BRIDGEPORT, CT 06604(203) 615-1405 Get Directions Write a Review

NPPES record last updated: October 29, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kelly Dougherty Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KELLY DOUGHERTY LCSW (NPI 1023615614) is an individual clinical provider in Bridgeport, Connecticut, licensed in Connecticut (013971) and active in the NPI registry since October 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2020).

NPPES Registry Identity

NPI1023615614
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameKELLY DOUGHERTYCredential: LCSW
Location Address2625 PARK AVE UNIT 2JBridgeport, CT 06604-1337
Mailing Address2625 Park Ave Unit 2jBridgeport, CT 06604-1337 · (203) 615-1405
Phone(203) 615-1405
Sole ProprietorNo
Medical School CMSOtherGraduated 2020
Enumeration DateOctober 6, 2020
Last NPPES UpdateOctober 29, 2025
NPPES CertifiedOctober 29, 2025
✔ NPI 1023615614 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in CT · 013971
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedSocial WorkerTaxonomy 104100000X
2625 PARK AVE UNIT 2J, Bridgeport, CT 06604
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Dougherty Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5092280156
PECOS Enrollment IDI20260407001932
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kelly Dougherty reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern Connecticut Christian Counseling Center
3.1 mi
Community/Behavioral Health
8 WAKEMAN RD
Fairfield, CT 06824
  • Reassigned Medicare billing, Connecticut enrollment
  • 19 clinicians in this Medicare group
NPI 1164652871 (203) 255-5078

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 06604 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $60.82 – $183.10
Typical copayment $0.00 (range $15.20 – $45.77)
Most-billed visit code NA
Established Patient
$75.55 typical visit price
range $19.76 – $149.26
Typical copayment $18.88 (range $4.94 – $37.31)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kelly Dougherty's NPI number?

The NPI number for Kelly Dougherty is 1023615614. It was assigned to this individual provider in the NPPES registry on October 6, 2020.

Where is Kelly Dougherty located?

Kelly Dougherty practices at 2625 Park Ave Unit 2J, Bridgeport, CT 06604. The listed phone number is (203) 615-1405.

What is Kelly Dougherty's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kelly Dougherty enrolled in Medicare?

Yes. Kelly Dougherty is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kelly Dougherty's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Dougherty reassigns Medicare benefits to Southern Connecticut Christian Counseling Center (Fairfield, CT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Dougherty's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Kelly Dougherty was last updated on October 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.