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General NPI Number Information
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NPI Number | 1629469515
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Entity Type | Individual
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Provider Name | PATRICIA WALSH
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Gender | Female
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 380 S SAN DIMAS AVE
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City | SAN DIMAS
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State | CA
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Zip | 91773-4036
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Country | US
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Telephone | 626-804-0100
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Fax | 626-963-9174
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Provider Business Mailing Address
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Address Line | 380 S SAN DIMAS AVE
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City | SAN DIMAS
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State | CA
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Zip | 91773-4036
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Country | US
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Telephone | 626-804-0100
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Fax | 626-963-9174
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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 | 24609
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License Number State | CA
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