Healthcare Provider Details

I. General information

NPI: 1275866345
Provider Name (Legal Business Name): MOIRA DALY LMFT 0149731
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 MENAUL BLVD NE STE 102C
ALBUQUERQUE NM
87112-2465
US

IV. Provider business mailing address

7508 CUTLER AVE NE
ALBUQUERQUE NM
87110-4502
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-1856
  • Fax: 505-883-2571
Mailing address:
  • Phone: 505-269-1856
  • Fax: 505-883-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT-0119981
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0149731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: