Healthcare Provider Details

I. General information

NPI: 1962363473
Provider Name (Legal Business Name): KIMBERLY DALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1R NEWBURY ST STE 401
PEABODY MA
01960-3816
US

IV. Provider business mailing address

8 PENN RD
PEABODY MA
01960-3332
US

V. Phone/Fax

Practice location:
  • Phone: 617-804-2773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: