Healthcare Provider Details

I. General information

NPI: 1023359403
Provider Name (Legal Business Name): MATTHEW PETER DALEO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 05/09/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 CAROL LYNN DR
KOKOMO IN
46901-3282
US

IV. Provider business mailing address

1766 CAROL LYNN DR
KOKOMO IN
46901-3282
US

V. Phone/Fax

Practice location:
  • Phone: 657-461-9733
  • Fax:
Mailing address:
  • Phone: 657-461-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011773A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: