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General NPI Number Information
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NPI Number | 1437800075
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Entity Type | Individual
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Provider Name | OLIVIA WALSH LSW
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Gender | Female
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Dates
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Enumeration Date | 01/14/2022
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 100 FODEN RD STE 100
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2327
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Country | US
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Telephone | 207-874-1486
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SOUTHBOROUGH DR STE 120
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6978
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Country | US
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Telephone | 207-347-2947
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Fax | 207-874-1483
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LC24869
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License Number State | ME
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