Provider Demographics
NPI:1275866345
Name:DALY, MOIRA (LMFT 0149731)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:LMFT 0149731
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7508 CUTLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4502
Mailing Address - Country:US
Mailing Address - Phone:505-269-1856
Mailing Address - Fax:505-883-2571
Practice Address - Street 1:11930 MENAUL BLVD NE STE 102C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2465
Practice Address - Country:US
Practice Address - Phone:505-259-1856
Practice Address - Fax:505-883-2571
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0119981101YP2500X
101Y00000X
NM0149731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36050075Medicare PIN