Healthcare Provider Details

I. General information

NPI: 1629901715
Provider Name (Legal Business Name): MOLLY ROSE WALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 PLEASANT ST UNIT 5
CONCORD NH
03301-2931
US

IV. Provider business mailing address

1 BROADWAY STE 14
CAMBRIDGE MA
02142-1187
US

V. Phone/Fax

Practice location:
  • Phone: 412-414-1811
  • Fax:
Mailing address:
  • Phone: 412-414-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: