Healthcare Provider Details

I. General information

NPI: 1518583467
Provider Name (Legal Business Name): SAMANTHA DALY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E MOUNT HOPE AVE
LANSING MI
48910-1913
US

IV. Provider business mailing address

2500 E GRAND RIVER AVE
LANSING MI
48912-4314
US

V. Phone/Fax

Practice location:
  • Phone: 517-648-9376
  • Fax:
Mailing address:
  • Phone: 231-330-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801120521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: