MEDICARE: KATHERINE DALEY MA, LPCC, RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD.10853	OH
2	101YM0800X	Mental Health Counselor	LPCC.0021722	CO

General Provider Information

NPI Number	:	1043938434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DALEY MA, LPCC, RDN

Provider Business Mailing Address
First Line	:	54 JAMES VINCENT DR
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-1259
Country	:	US
Telephone Number	:	860-876-0637
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 E ASBURY AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-4371
Country	:	US
Telephone Number	:	860-876-0637
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	12/21/2025

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