MEDICARE: RICHARD LEWIS WALSH 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	SW20476	FL

General Provider Information

NPI Number	:	1801510581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LEWIS WALSH MSW, LCSW

Provider Business Mailing Address
First Line	:	75 VINEYARDS BLVD STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4748
Country	:	US
Telephone Number	:	239-326-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 VINEYARDS BLVD STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4748
Country	:	US
Telephone Number	:	239-326-0796
Fax Number	:

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

Provider Enumeration Date	:	09/27/2022
Last Update Date	:	04/05/2024

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