Provider Demographics
NPI:1164552485
Name:DALEY, BRENDA LOUISE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LOUISE
Last Name:DALEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-986-6607
Mailing Address - Fax:617-436-0187
Practice Address - Street 1:1125 TREMONT ST
Practice Address - Street 2:ROXBURY CROSSING
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2178
Practice Address - Country:US
Practice Address - Phone:617-427-1000
Practice Address - Fax:617-989-3125
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW 1131621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical