Healthcare Provider Details

I. General information

NPI: 1366182701
Provider Name (Legal Business Name): WALTER BELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E 207TH ST APT 5K
BRONX NY
10467-4056
US

IV. Provider business mailing address

277 E 207TH ST APT 5K
BRONX NY
10467-4056
US

V. Phone/Fax

Practice location:
  • Phone: 347-872-0551
  • Fax:
Mailing address:
  • Phone: 347-872-0551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19466
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: