Provider Demographics
NPI:1225605538
Name:DALY, AMY BETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:DALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 PINE WOOD LN
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1315
Mailing Address - Country:US
Mailing Address - Phone:317-523-5644
Mailing Address - Fax:
Practice Address - Street 1:314 PINE WOOD LN
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1315
Practice Address - Country:US
Practice Address - Phone:317-523-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-06
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical