Healthcare Provider Details

I. General information

NPI: 1992525083
Provider Name (Legal Business Name): ANGELA LEE WALKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE BLDG 104
BATH NY
14810-0810
US

IV. Provider business mailing address

76 VETERANS AVE BLDG 104
BATH NY
14810-0810
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4327
  • Fax:
Mailing address:
  • Phone: 607-664-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: