Healthcare Provider Details

I. General information

NPI: 1790841963
Provider Name (Legal Business Name): MARIANNE WALSH M.S.W., M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MILTON RD APARTMENT G12
RYE NY
10580-3850
US

IV. Provider business mailing address

PO BOX 942
SUFFERN NY
10901-0942
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-9554
  • Fax:
Mailing address:
  • Phone: 845-368-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW SC06014
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW R033920-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: