Provider Demographics
NPI:1871504910
Name:DALY, BARRY (EDD,LMHC,BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:EDD,LMHC,BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0364
Mailing Address - Country:US
Mailing Address - Phone:321-436-8445
Mailing Address - Fax:407-298-9166
Practice Address - Street 1:800 S EUSTIS ST
Practice Address - Street 2:SUITE G & H
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4886
Practice Address - Country:US
Practice Address - Phone:321-436-8445
Practice Address - Fax:407-298-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2399101YA0400X
FL05047101YM0800X, 251B00000X
FL5047101YP2500X
FL1-00-0254103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001679600Medicaid
FL008750400Medicaid
FL003888800Medicaid
FL283455Medicaid
FL008316100Medicaid
FL683791396Medicaid
FL303984Medicaid