Provider Demographics
NPI:1134508583
Name:DALY, PAMELA JEAN JR (MA, CAGS, LMHC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:DALY
Suffix:JR
Gender:F
Credentials:MA, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1104
Mailing Address - Country:US
Mailing Address - Phone:508-769-2766
Mailing Address - Fax:
Practice Address - Street 1:24 FALCON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1104
Practice Address - Country:US
Practice Address - Phone:508-769-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health