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General NPI Number Information
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NPI Number | 1790220598
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Entity Type | Organization
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Legal Business Name | WALTERS PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 504 ALDRICH RD
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City | HOWELL
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State | NJ
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Zip | 07731-1978
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Country | US
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Telephone | 848-231-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 504 ALDRICH RD
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City | HOWELL
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State | NJ
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Zip | 07731-1978
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Country | US
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Telephone | 848-231-9460
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | CHRISTINA WALTERS
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Credential | PSY.D.
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Telephone | 848-231-9460
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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 | 35S100548200
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License Number State | NJ
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