Healthcare Provider Details

I. General information

NPI: 1093588402
Provider Name (Legal Business Name): DANIEL JORDAN DELANEY PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WATERMAN ST STE 200
PROVIDENCE RI
02906-4313
US

IV. Provider business mailing address

220 CARPENTER ST
PROVIDENCE RI
02903-3047
US

V. Phone/Fax

Practice location:
  • Phone: 401-217-3651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02228
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: