Provider Demographics
NPI:1386135531
Name:DAILY, JEFF RANDALL
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:RANDALL
Last Name:DAILY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BELMONT ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3541
Mailing Address - Country:US
Mailing Address - Phone:617-855-8463
Mailing Address - Fax:
Practice Address - Street 1:266 BELMONT ST UNIT 3
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3541
Practice Address - Country:US
Practice Address - Phone:617-855-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2024-06-12
Deactivation Date:2021-12-21
Deactivation Code:
Reactivation Date:2022-01-11
Provider Licenses
StateLicense IDTaxonomies
MAPSY11814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical