Provider Demographics
NPI:1992680680
Name:DALY, KAITLIN (MA, AMFT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 MELROSE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3738
Mailing Address - Country:US
Mailing Address - Phone:312-810-1277
Mailing Address - Fax:
Practice Address - Street 1:500 N ROSSMORE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-2435
Practice Address - Country:US
Practice Address - Phone:312-810-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist