Provider Demographics
NPI:1598849564
Name:DALY, EDWARD VINCENT (LSSA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:VINCENT
Last Name:DALY
Suffix:
Gender:M
Credentials:LSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SAN CARLOS RD SW APT 11
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1060
Mailing Address - Country:US
Mailing Address - Phone:505-344-6738
Mailing Address - Fax:505-344-1862
Practice Address - Street 1:1217 1ST ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87125-0445
Practice Address - Country:US
Practice Address - Phone:505-344-6738
Practice Address - Fax:505-344-1862
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)