Healthcare Provider Details

I. General information

NPI: 1447310610
Provider Name (Legal Business Name): MARIANNE F WALTERS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PROSPECT AVE
SEA CLIFF NY
11579-1048
US

IV. Provider business mailing address

222 PROSPECT AVE
SEA CLIFF NY
11579-1048
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-3830
  • Fax:
Mailing address:
  • Phone: 516-609-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014114-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: