MEDICARE: STACY DALY LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376320705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY DALY LLC

Provider Business Mailing Address
First Line	:	1531 BERTRAM ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-1926
Country	:	US
Telephone Number	:	808-772-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 BERTRAM ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-1926
Country	:	US
Telephone Number	:	808-772-1191
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	STACY DALY
Credential	:	LCSW
Telephone Number	:	808-737-1007

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	04/07/2025

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