Provider Demographics
NPI:1811645435
Name:MCLEAN-DALY, SHERISE (LMSW)
Entity type:Individual
Prefix:
First Name:SHERISE
Middle Name:
Last Name:MCLEAN-DALY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4719
Mailing Address - Country:US
Mailing Address - Phone:718-986-8501
Mailing Address - Fax:
Practice Address - Street 1:58 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4719
Practice Address - Country:US
Practice Address - Phone:718-986-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041S0200X
NY097476104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool