=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366925471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DALY COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2018
-----------------------------------------------------
Last Update Date | 09/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 THOMPSON ST STE A106
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06513-5707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-522-3755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3112
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460-0912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-522-3755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | DEBRA DALY-GANNON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 203-522-3755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------