Provider Demographics
NPI:1952469900
Name:DALY, THOMAS (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:THOMAS
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3107
Mailing Address - Country:US
Mailing Address - Phone:718-836-6060
Mailing Address - Fax:
Practice Address - Street 1:371 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3107
Practice Address - Country:US
Practice Address - Phone:718-836-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026038-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN80012Medicare ID - Type UnspecifiedMEDICARE PROVIDER