MEDICARE: RUSSELL A WALSH PH.D.

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	103TC0700X	Clinical Psychologist	PS008249L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	464910	OTHER	PA	VALUEOPTIONS
2	276894	OTHER	PA	HIGHMARK BC BS

General Provider Information

NPI Number	:	1235178740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL A WALSH PH.D.

Provider Business Mailing Address
First Line	:	214 BROOKSIDE DR
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-4666
Country	:	US
Telephone Number	:	412-418-2830
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 BROOKTREE CT STE 250
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-9271
Country	:	US
Telephone Number	:	412-418-2830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/22/2026

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