MEDICARE: KAREN JEANINE MULCAHY WALSH LBA, BCBA

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	103K00000X	Behavior Analyst	71000154	NY

General Provider Information

NPI Number	:	1508680117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN JEANINE MULCAHY WALSH LBA, BCBA

Provider Business Mailing Address
First Line	:	7 VON HAGEN AVE
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2126
Country	:	US
Telephone Number	:	631-896-9125
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 VON HAGEN AVE
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2126
Country	:	US
Telephone Number	:	631-896-9125
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	02/19/2026

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