Provider Demographics
NPI:1710011739
Name:DALY, JILLIANN (PH D)
Entity Type:Individual
Prefix:DR
First Name:JILLIANN
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:375 LAGUNA HONDA BLVD
Mailing Address - Street 2:LAGUNA HONDA HOSPITAL AND REHAB CTR, MEDICAL SVCS
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1411
Mailing Address - Country:US
Mailing Address - Phone:415-759-2300
Mailing Address - Fax:415-759-2374
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:LAGUNA HONDA HOSPITAL AND REHAB CENTER, MEDICAL SVCS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-759-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS52795Medicare UPIN