Provider Demographics
NPI:1386861680
Name:DALY, BETH ANN (CADC, MISA II, NCRS)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:DALY
Suffix:
Gender:F
Credentials:CADC, MISA II, NCRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 N BEACON ST APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4866
Mailing Address - Country:US
Mailing Address - Phone:773-506-9520
Mailing Address - Fax:773-506-9531
Practice Address - Street 1:4735 N BEACON ST APT 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4866
Practice Address - Country:US
Practice Address - Phone:773-506-9520
Practice Address - Fax:773-506-9531
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12211101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)