Provider Demographics
NPI:1831277961
Name:DALEY, ROBERT EDMUND (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDMUND
Last Name:DALEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 CASHMAN WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-1473
Mailing Address - Country:US
Mailing Address - Phone:718-544-0764
Mailing Address - Fax:978-972-5946
Practice Address - Street 1:7136 110TH ST
Practice Address - Street 2:STE 1H
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4836
Practice Address - Country:US
Practice Address - Phone:718-544-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27818Medicare UPIN