Provider Demographics
NPI:1366925471
Name:DALY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:DALY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY-GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:203-522-3755
Mailing Address - Street 1:PO BOX 3112
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-0912
Mailing Address - Country:US
Mailing Address - Phone:203-522-3755
Mailing Address - Fax:
Practice Address - Street 1:64 THOMPSON ST STE A106
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-5707
Practice Address - Country:US
Practice Address - Phone:203-522-3755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962993444Medicaid