Provider Demographics
NPI:1699088302
Name:DALY, LISA MARIA (LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:DALY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S CALIFORNIA AVE
Mailing Address - Street 2:#205
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1642
Mailing Address - Country:US
Mailing Address - Phone:650-248-8124
Mailing Address - Fax:
Practice Address - Street 1:230 S CALIFORNIA AVE
Practice Address - Street 2:#205
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1642
Practice Address - Country:US
Practice Address - Phone:650-248-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44881106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist