MEDICARE: JASON M WALTER LCSW PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023726312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON M WALTER LCSW PC

Provider Business Mailing Address
First Line	:	177 PRINCE STREET
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10012-2936
Country	:	US
Telephone Number	:	312-296-9405
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 PRINCE STREET
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10012-2936
Country	:	US
Telephone Number	:	312-296-9405
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. JASON WALTER
Credential	:	LCSW
Telephone Number	:	312-296-9405

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	11/07/2022

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