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General NPI Number Information
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NPI Number | 1144562604
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Entity Type | Individual
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Provider Name | JASON WALTER LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 177 PRINCE STREET SUITE 204
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City | NEW YORK
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State | NY
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Zip | 10012-2936
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Country | US
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Telephone | 917-243-9989
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Fax |
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Provider Business Mailing Address
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Address Line | 177 PRINCE STREET SUITE 204
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City | NEW YORK
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State | NY
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Zip | 10012-2936
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Country | US
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Telephone | 312-296-9405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 084619
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License Number State | NY
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