Provider Demographics
NPI:1861503021
Name:DALY, DANIEL J (ACSW, LICSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:DALY
Suffix:
Gender:M
Credentials:ACSW, LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PROSPECT HILL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3128
Mailing Address - Country:US
Mailing Address - Phone:401-849-7334
Mailing Address - Fax:
Practice Address - Street 1:145 PROSPECT HILL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3128
Practice Address - Country:US
Practice Address - Phone:401-849-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW001431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI168-1OtherBLUE CHIP/CONTINUUM PROVI
RI3841-4OtherBC/BS INDEPENDENT PROVIDE
RIDD00366Medicaid