Healthcare Provider Details

I. General information

NPI: 1538213962
Provider Name (Legal Business Name): TAMMY L KINIRY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PEMBROKE RD
CONCORD NH
03301-5792
US

IV. Provider business mailing address

9 VAN GER DR
BOW NH
03304-4912
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-7554
  • Fax: 603-881-7533
Mailing address:
  • Phone: 603-856-8655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number171
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: