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General NPI Number Information
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NPI Number | 1902394232
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Entity Type | Individual
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Provider Name | SEAN WALSH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1707 BELLE VIEW BLVD APT C1
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City | ALEXANDRIA
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State | VA
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Zip | 22307-6727
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Country | US
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Telephone | 202-875-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 EUCLID ST NW APT 42
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City | WASHINGTON
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State | DC
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Zip | 20009-5333
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Country | US
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Telephone | 248-860-0032
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005839
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License Number State | VA
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