Healthcare Provider Details

I. General information

NPI: 1053328567
Provider Name (Legal Business Name): JOHN ANTHONY WALSH JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GILFORD AVE # 1C
GILFORD NH
03249-7500
US

IV. Provider business mailing address

PO BOX 7274 401 GILFORD AVE., #1C
LACONIA NH
03247-7274
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-2307
  • Fax: 603-528-2257
Mailing address:
  • Phone: 603-528-2307
  • Fax: 603-528-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number253
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: