Maryellen Daly, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

106945 Issued in MA

Practice address

209 Quincy St
Brockton, MA 02302-2926

Phone

(508) 942-2143

Fax

(508) 897-2075

NPI assigned

Jan 13, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468368000000",
    "number": "1225189657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 QUINCY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022988",
            "telephone_number": "508-897-2082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 QUINCY ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023022926",
            "telephone_number": "508-942-2143",
            "fax_number": "508-897-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALY",
        "first_name": "MARYELLEN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-13",
        "last_updated": "2016-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "106945",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW00223",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305565",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "166343000",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Daks, PHD
• Jeanine Mary Dalessio, MSW, LICSW
• Allison Daley, LICSW
• Lisa Marie Daley, LMHC
• Whitfield Perry Daley
• Samantha Daine Dam, LPN
• Astrid Damas
• Erica Christine Damiano, COTA/L
• Ruinide Danger-Alexis, MA
• Gabriella Daniel

• Clinical Social Worker in Brockton, MA
• Providers in Brockton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.