Provider Demographics
NPI:1770530610
Name:DALY, CHRISTINE MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
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 1:8 MONTEREY LANE
Mailing Address - Street 2:
Mailing Address - City:SO YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664
Mailing Address - Country:US
Mailing Address - Phone:508-760-3969
Mailing Address - Fax:508-775-1245
Practice Address - Street 1:1019 ROUTE 132
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-778-1839
Practice Address - Fax:508-775-1245
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1304887Medicaid
MAP22833Medicare ID - Type Unspecified