MEDICARE: MS. MICHELLE JOAN WALTER MSW, LCSW

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	1041C0700X	Clinical Social Worker	0904002919	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	076707	OTHER	VA	BLUE CROSS

General Provider Information

NPI Number	:	1043236060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE JOAN WALTER MSW, LCSW

Provider Business Mailing Address
First Line	:	5000 CORPORATE WOODS DR
Second Line	:	STE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4429
Country	:	US
Telephone Number	:	757-459-4640
Fax Number	:	757-459-4643

Provider Business Practice Location Address
First Line	:	260 GRAYSON ROAD
Second Line	:	JEWISH FAMILY SERVICE OF TIDEWATER INC
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4345
Country	:	US
Telephone Number	:	757-459-4640
Fax Number	:	757-459-4643

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/18/2019

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