Provider Demographics
NPI:1023128196
Name:DALY, JEFF STEPHEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:STEPHEN
Last Name:DALY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 COLDWATER CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4707
Mailing Address - Country:US
Mailing Address - Phone:858-547-1853
Mailing Address - Fax:
Practice Address - Street 1:15725 POMERADO RD STE 107
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2057
Practice Address - Country:US
Practice Address - Phone:858-376-0230
Practice Address - Fax:760-688-4045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical