Provider Demographics
NPI:1922167154
Name:MALONE, TARA CATHERINE (M ED)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:CATHERINE
Last Name:MALONE
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FARNHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1629
Mailing Address - Country:US
Mailing Address - Phone:978-432-1855
Mailing Address - Fax:978-745-7772
Practice Address - Street 1:10 LIBERTY ST
Practice Address - Street 2:SUITE 117
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2577
Practice Address - Country:US
Practice Address - Phone:978-432-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health