Healthcare Provider Details

I. General information

NPI: 1720502529
Provider Name (Legal Business Name): DANIELLE ERICA WALSH OTR/L, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTENNIAL DR STE 100
PEABODY MA
01960-7906
US

IV. Provider business mailing address

5 CENTENNIAL DR STE 100
PEABODY MA
01960-7906
US

V. Phone/Fax

Practice location:
  • Phone: 978-232-0332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2373423
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number12235
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: