Provider Demographics
NPI:1316167836
Name:DALY, DAVID GLENNON (LCSW, CASAC, BCD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GLENNON
Last Name:DALY
Suffix:
Gender:M
Credentials:LCSW, CASAC, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3226
Mailing Address - Country:US
Mailing Address - Phone:914-997-8088
Mailing Address - Fax:914-997-9553
Practice Address - Street 1:119 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-3226
Practice Address - Country:US
Practice Address - Phone:914-997-8088
Practice Address - Fax:914-997-9553
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR050001-1101YA0400X, 102L00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02275309Medicaid
NY02275309Medicaid