Kelly Dougherty, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

013971 Issued in CT

Practice address

2625 Park Ave Unit 2J
Bridgeport, CT 06604-1337

Phone

(203) 615-1405

NPI assigned

Oct 6, 2020

Last updated

Oct 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern Connecticut Christian Counseling Center

  dba Renew Counseling Associates

  • Community/Behavioral Health Agency
  • Fairfield, CT
  • NPI 1164652871
  Medicare reassignment
• Progressive Institute LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shelton, CT
  • NPI 1669944724
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1023615614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 PARK AVE UNIT 2J",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041337",
            "telephone_number": "203-615-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 PARK AVE UNIT 2J",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041337",
            "telephone_number": "203-615-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "KELLY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-06",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "013971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Weethne Dorvil, BS
• Elizabeth A Dos Santos
• Siomara Dos Santos
• Ryan Scott Doss, M.D.
• Betty Dossantos, LADC
• Claire Morgan Douglas
• Nadine Chanair Douglas, LMSW
• Julian Natalie Downey, LPN
• Downtown Dental P.C.
• Kirstin Dowsett, LCSW

• Clinical Social Worker in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.