Provider Demographics
NPI:1295378768
Name:DALY, ELIZABETH JORDAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JORDAN
Last Name:DALY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 WHITTIER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4549
Mailing Address - Country:US
Mailing Address - Phone:703-734-0787
Mailing Address - Fax:703-734-2735
Practice Address - Street 1:6801 WHITTIER AVE STE 300
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4549
Practice Address - Country:US
Practice Address - Phone:703-734-0787
Practice Address - Fax:703-734-2735
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical