Provider Demographics
NPI:1699597229
Name:DALY, TAMARA TAYLOR (PMHNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:TAYLOR
Last Name:DALY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:TAYLOR
Other - Last Name:LIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 BRYON RD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3304
Mailing Address - Country:US
Mailing Address - Phone:617-894-0637
Mailing Address - Fax:
Practice Address - Street 1:10 BRYON RD APT 1
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3304
Practice Address - Country:US
Practice Address - Phone:617-894-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN228984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health