MEDICARE: MARISSA LYNN DALY LCSW

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	1041C0700X	Clinical Social Worker	CSW00787	RI

General Provider Information

NPI Number	:	1740065762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LYNN DALY LCSW

Provider Business Mailing Address
First Line	:	50 GLEN HILLS DR
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-4527
Country	:	US
Telephone Number	:	401-270-8005
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 GLEN HILLS DR
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02920-4527
Country	:	US
Telephone Number	:	401-270-8005
Fax Number	:

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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