MEDICARE: ROSALYN WALTERS LMSW

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	171M00000X	Case Manager/Care Coordinator		LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1679051551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN WALTERS LMSW

Provider Business Mailing Address
First Line	:	4700 WICHERS DR STE 206
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 EASTERN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-6226
Country	:	US
Telephone Number	:	504-352-1231
Fax Number	:

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

Provider Enumeration Date	:	08/01/2018
Last Update Date	:	10/15/2018

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