Provider Demographics
NPI:1043938434
Name:DALEY, KATHERINE (MA, LPCC, RDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:MA, LPCC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 JAMES VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1259
Mailing Address - Country:US
Mailing Address - Phone:860-876-0637
Mailing Address - Fax:
Practice Address - Street 1:54 JAMES VINCENT DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1259
Practice Address - Country:US
Practice Address - Phone:860-876-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
COLPCC.0021722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health