Healthcare Provider Details

I. General information

NPI: 1083199582
Provider Name (Legal Business Name): DALY KAT KOBOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 TOPEKA ST
BOSTON MA
02118-2717
US

IV. Provider business mailing address

320 SARATOGA ST APT 3
EAST BOSTON MA
02128-1413
US

V. Phone/Fax

Practice location:
  • Phone: 617-442-1499
  • Fax:
Mailing address:
  • Phone: 860-519-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: