Stephanie Doughty Kilgannon

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

54 Cherry St
Massapequa, NY 11758-5117

Phone

(718) 791-7487

NPI assigned

Nov 19, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Stephanie Doughty Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637280000000",
    "number": "1669139085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 CHERRY ST",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585117",
            "telephone_number": "718-791-7487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 CHERRY ST",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585117",
            "telephone_number": "718-791-7487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILGANNON",
        "first_name": "STEPHANIE",
        "middle_name": "DOUGHTY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2021-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "DOUGHTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David B Kessler, D.O.
• Sandra J Ketcham, PT
• Eric Khairi, PA
• Irina Kholodny, R-PAC
• Heidi L Kiernan, L.AC.
• Barbara Ann Kilgus, LCSW-R
• James J Kim
• Jiyon Jennifer Kim, P.A.-C., MPAS
• Young Chul Kim
• Kenisha Tedra King

• Mental Health Counselor in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.