MEDICARE: DR. TODD WALTER PHD

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	103T00000X	Psychologist	017187	NY

General Provider Information

NPI Number	:	1548040454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD WALTER PHD

Provider Business Mailing Address
First Line	:	7236 WILROSE CT
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1481
Country	:	US
Telephone Number	:	716-946-5841
Fax Number	:

Provider Business Practice Location Address
First Line	:	7236 WILROSE CT
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-1481
Country	:	US
Telephone Number	:	716-946-5841
Fax Number	:

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

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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