Provider Demographics
NPI:1144463910
Name:DALEY, DALE THOMAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:THOMAS
Last Name:DALEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 BROADWAY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1222
Mailing Address - Country:US
Mailing Address - Phone:917-592-8743
Mailing Address - Fax:212-764-6404
Practice Address - Street 1:345 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3033
Practice Address - Country:US
Practice Address - Phone:917-592-8743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051801-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical