MEDICARE: LAURIE A DALEY CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	670	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	034264	OTHER		MEDICARE B
3	P00094869	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7717583	OTHER	AETNA/US HEALTHCARE
6	AD0159	OTHER	BLUE CARE ELECT
7	042472266039	OTHER	TRICARE/CHAMPUS
8	AA3497	OTHER	HARVARD PILGRIM HEALTHCAR
9	AD0159	OTHER	BLUE SHIELD INDEMNITY
10	AD0159	OTHER	BLUE SHIELD HMO BLUE
11	54426	OTHER	FALLON COMM. HEALTH PLAN

General Provider Information

NPI Number	:	1871575845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE A DALEY CCC-A

Provider Business Mailing Address
First Line	:	295 LINCOLN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-755-1391
Fax Number	:	508-363-4019

Provider Business Practice Location Address
First Line	:	295 LINCOLN ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01605-3639
Country	:	US
Telephone Number	:	508-755-1391
Fax Number	:	508-363-4019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/02/2010

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Directions to “ LAURIE A DALEY CCC-A” Practice Location

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