Healthcare Provider Details

I. General information

NPI: 1497422539
Provider Name (Legal Business Name): JODI WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

IV. Provider business mailing address

2003 SEVILLE ST
MARGATE FL
33063-2473
US

V. Phone/Fax

Practice location:
  • Phone: 866-991-2103
  • Fax:
Mailing address:
  • Phone: 954-805-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierSW15020
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerSTATE LICENSING BOARD
# 2
Identifier113437
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerSTATE LICENSING BOARD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: