Provider Demographics
NPI:1992166425
Name:DALY, LORRAINE (MA, MS, NCSP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:MA, MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 NARCISSUS RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8726
Mailing Address - Country:US
Mailing Address - Phone:631-466-4848
Mailing Address - Fax:
Practice Address - Street 1:15 NARCISSUS RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8726
Practice Address - Country:US
Practice Address - Phone:631-466-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY42134103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY42134OtherNCSP