Provider Demographics
NPI:1205812054
Name:DALEY, THOMAS J (LCSW-R)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:DALEY
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PARK PL
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-5211
Mailing Address - Country:US
Mailing Address - Phone:518-295-8336
Mailing Address - Fax:
Practice Address - Street 1:113 PARK PL
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5211
Practice Address - Country:US
Practice Address - Phone:518-295-8336
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0400531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03004280OtherMEDICAID AGENCY
NY400201096001OtherCDPHP
NY53415AOtherMEDICARE AGENCY PIN