Provider Demographics
NPI:1548293269
Name:DALY, MARY HERBERT (LCSW)
Entity type:Individual
Prefix:
First Name:MARY HERBERT
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 LARCHMONT CRES
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1401
Mailing Address - Country:US
Mailing Address - Phone:757-489-7820
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:4TH FLOOR SOCIAL WORK DEPT.
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-9350
Practice Address - Fax:757-668-7950
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140793OtherANTHEM
VAPIN 343394OtherTRICARE
VA89-19755Medicaid
VAO86234OtherSENTARA