MEDICARE: CHRISTINE WALZAK LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	012533	NY

General Provider Information

NPI Number	:	1013766146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE WALZAK LMHC

Provider Business Mailing Address
First Line	:	418 BROADWAY # 8454
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 ROUTE 112 STE C
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3663
Country	:	US
Telephone Number	:	631-291-2385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	08/31/2025

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