Provider Demographics
NPI:1568436467
Name:DALEY, JENNIFER KATHERINE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KATHERINE
Last Name:DALEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARSETT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6640
Mailing Address - Country:US
Mailing Address - Phone:802-448-2138
Mailing Address - Fax:802-985-0748
Practice Address - Street 1:10 MARSETT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-6640
Practice Address - Country:US
Practice Address - Phone:802-448-2138
Practice Address - Fax:802-985-0748
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900009981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010504Medicaid
VT1010504Medicaid