1922107069 NPI number — MR. RICHARD VINCENT DALY III LCSW

Table of content: MR. RICHARD VINCENT DALY III LCSW (NPI 1922107069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922107069 NPI number — MR. RICHARD VINCENT DALY III LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALY
Provider First Name:
RICHARD
Provider Middle Name:
VINCENT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922107069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 TOWER AVENUE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-714-2750
Provider Business Mailing Address Fax Number:
860-714-8591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 SYCAMORE COMMONS
Provider Second Line Business Practice Location Address:
SUITE 201A
Provider Business Practice Location Address City Name:
GLASTONBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-2750
Provider Business Practice Location Address Fax Number:
860-714-8591
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  004657 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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