Healthcare Provider Details

I. General information

NPI: 1679333512
Provider Name (Legal Business Name): MAYA DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEA HAWK WAY
REDONDO BEACH CA
90277-2976
US

IV. Provider business mailing address

2622 W 78TH PL
INGLEWOOD CA
90305-1024
US

V. Phone/Fax

Practice location:
  • Phone: 310-798-8665
  • Fax:
Mailing address:
  • Phone: 323-533-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number156067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: