Provider Demographics
NPI:1457924904
Name:DALEY, JOHN FREDERICK (LMSW-CLINICAL)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREDERICK
Last Name:DALEY
Suffix:
Gender:M
Credentials:LMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14519 RICE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2936
Mailing Address - Country:US
Mailing Address - Phone:586-243-4724
Mailing Address - Fax:
Practice Address - Street 1:441 S LIVERNOIS RD STE 190
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2591
Practice Address - Country:US
Practice Address - Phone:248-650-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010898971041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical