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General NPI Number Information
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NPI Number | 1588102529
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Entity Type | Organization
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Legal Business Name | DR. SYDNEY WALSH PLLC
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Dates
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Enumeration Date | 02/10/2017
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 28345 BECK RD STE 305
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City | WIXOM
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State | MI
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Zip | 48393-4744
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Country | US
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Telephone | 248-491-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 28345 BECK RD STE 305
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City | WIXOM
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State | MI
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Zip | 48393-4744
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Country | US
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Telephone | 248-491-8047
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SYDNEY A WALSH
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Credential | PH.D. LP
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Telephone | 248-854-8279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016444
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License Number State | MI
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