Provider Demographics
NPI:1538282231
Name:DALY, BONNIE ROSE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:ROSE
Last Name:DALY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:ROSE
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:964 5TH AVE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6102
Mailing Address - Country:US
Mailing Address - Phone:619-544-1435
Mailing Address - Fax:619-544-1439
Practice Address - Street 1:964 5TH AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6102
Practice Address - Country:US
Practice Address - Phone:619-544-1435
Practice Address - Fax:619-544-1439
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 22840106H00000X
CARN 104963163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult