MEDICARE: JOANN WALSH LCSW

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	101YM0800X	Mental Health Counselor	0904000611	VA

General Provider Information

NPI Number	:	1326151929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN WALSH LCSW

Provider Business Mailing Address
First Line	:	6400 SEVEN CORNERS PL
Second Line	:	SUITE R
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2009
Country	:	US
Telephone Number	:	703-536-4622
Fax Number	:	703-536-4622

Provider Business Practice Location Address
First Line	:	6400 SEVEN CORNERS PL
Second Line	:	SUITE R
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2009
Country	:	US
Telephone Number	:	703-536-4622
Fax Number	:	703-536-4622

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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