Healthcare Provider Details

I. General information

NPI: 1841324910
Provider Name (Legal Business Name): JANINE L DALEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARKET ST 2ND FLR
LYNN MA
01901
US

IV. Provider business mailing address

150 MARKET ST 2ND FLR CENTRAL SQUARE THERAPY ASSOCIATES
LYNN MA
01901
US

V. Phone/Fax

Practice location:
  • Phone: 781-592-6100
  • Fax:
Mailing address:
  • Phone: 781-592-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1026950
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: