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General NPI Number Information
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NPI Number | 1922474808
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Entity Type | Individual
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Provider Name | ELIZABETH ROSE WALSH LLBSW
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Gender | Female
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Dates
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Enumeration Date | 08/14/2015
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Last Update Date | 08/14/2015
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Provider Practice Location Address
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Address Line | 3430 3RD ST
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City | DETROIT
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State | MI
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Zip | 48201-2202
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Country | US
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Telephone | 313-832-3100
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Fax | 313-832-5271
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Provider Business Mailing Address
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Address Line | 496 WITHINGTON ST APT. 1
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City | FERNDALE
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State | MI
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Zip | 48220-2096
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Country | US
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Telephone | 989-573-4003
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6802087689
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License Number State | MI
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