Provider Demographics
NPI:1205155363
Name:DALY, PAUL (MA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:MA
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 2635
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95055-2635
Mailing Address - Country:US
Mailing Address - Phone:408-627-8144
Mailing Address - Fax:408-300-5225
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:SUITE 11D
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-627-8144
Practice Address - Fax:408-300-5225
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist