Provider Demographics
NPI:1295085546
Name:DALY, JUDITH C (LICSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:C
Last Name:DALY
Suffix:
Gender:F
Credentials:LICSW
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 731
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0731
Mailing Address - Country:US
Mailing Address - Phone:802-338-7377
Mailing Address - Fax:
Practice Address - Street 1:277 BLAIR PARK RD STE 210
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7885
Practice Address - Country:US
Practice Address - Phone:802-338-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00001861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical