Healthcare Provider Details

I. General information

NPI: 1285843102
Provider Name (Legal Business Name): DENISE MARIE WALTERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 VALLEY RD
MIDDLETOWN RI
02842-6401
US

IV. Provider business mailing address

77 BURNSIDE AVE
RIVERSIDE RI
02915-3224
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-6363
  • Fax: 401-848-6389
Mailing address:
  • Phone: 508-277-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00582
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: