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General NPI Number Information
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NPI Number | 1629197215
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Entity Type | Individual
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Provider Name | JOHN MARTIN WALTER LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 1301 CLAY ST 270S
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City | OAKLAND
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State | CA
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Zip | 94612
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Country | US
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Telephone | 510-587-5002
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Fax | 510-287-2417
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Provider Business Mailing Address
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Address Line | 1301 CLAY ST 270S
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City | OAKLAND
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State | CA
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Zip | 94612-5217
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Country | US
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Telephone | 510-587-5002
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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 | ASW17307
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 25652
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License Number State | CA
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