Provider Demographics
NPI:1871575845
Name:DALEY, LAURIE A (CCC-A)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:DALEY
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3639
Mailing Address - Country:US
Mailing Address - Phone:508-755-1391
Mailing Address - Fax:508-363-4019
Practice Address - Street 1:295 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3639
Practice Address - Country:US
Practice Address - Phone:508-755-1391
Practice Address - Fax:508-363-4019
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA670231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
034264OtherMEDICARE B
MA0396834Medicaid
P00094869OtherRAILROAD MEDICARE
0396834OtherMEDICAID/WELFARE
7717583OtherAETNA/US HEALTHCARE
AD0159OtherBLUE CARE ELECT
042472266039OtherTRICARE/CHAMPUS
AA3497OtherHARVARD PILGRIM HEALTHCAR
AD0159OtherBLUE SHIELD INDEMNITY
AD0159OtherBLUE SHIELD HMO BLUE
54426OtherFALLON COMM. HEALTH PLAN
54426OtherFALLON COMM. HEALTH PLAN
MA0396834Medicaid