MEDICARE: DR. WAYNE F DAILEY PH.D.

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	103TC0700X	Clinical Psychologist	920	CT

General Provider Information

NPI Number	:	1336262732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE F DAILEY PH.D.

Provider Business Mailing Address
First Line	:	18 HOPYARD RD
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1724
Country	:	US
Telephone Number	:	860-434-1535
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 HOPYARD RD
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1724
Country	:	US
Telephone Number	:	860-434-1535
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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