Provider Demographics
NPI:1366492449
Name:KATHLEEN A DALY MA LP PC
Entity Type:Organization
Organization Name:KATHLEEN A DALY MA LP PC
Other - Org Name:KATE DALY MA LP
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST/CORPORATE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:612-928-9021
Mailing Address - Street 1:3005 JAMES AVE S
Mailing Address - Street 2:# 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2589
Mailing Address - Country:US
Mailing Address - Phone:612-928-9021
Mailing Address - Fax:612-920-3680
Practice Address - Street 1:3005 JAMES AVE S
Practice Address - Street 2:# 300
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2589
Practice Address - Country:US
Practice Address - Phone:612-928-9021
Practice Address - Fax:612-920-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3213103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty