Healthcare Provider Details

I. General information

NPI: 1073189551
Provider Name (Legal Business Name): RICHARD CHARLES WALSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 SUNDALE AVE
BAKERSFIELD CA
93309-7908
US

IV. Provider business mailing address

PO BOX 5182
BAKERSFIELD CA
93388-5182
US

V. Phone/Fax

Practice location:
  • Phone: 661-399-3351
  • Fax:
Mailing address:
  • Phone: 661-399-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberLCSW121521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: