Provider Demographics
NPI:1720194962
Name:DALISKY, RALPH JOSEPH (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:JOSEPH
Last Name:DALISKY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 VETERANS DRIVE
Mailing Address - Street 2:A-111-SW YELLOW
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1174
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DRIVE
Practice Address - Street 2:A 111 SW YELLOW
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493
Practice Address - Country:US
Practice Address - Phone:253-583-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000090301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical