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General NPI Number Information
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NPI Number | 1366493082
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Entity Type | Individual
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Provider Name | MARY CONNELL TARAIL M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 1233 MAIN ST PROVIDENCE BEHAVIORAL HEALTH HOSPITAL
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City | HOLYOKE
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State | MA
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Zip | 01040-5381
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Country | US
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Telephone | 413-493-2765
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 MAIN STREET
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City | HOLYOKE
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State | MA
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Zip | 01040-1315
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Country | US
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Telephone | 413-552-6839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 206813
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 230267
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License Number State | MA
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