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NPI Code Detail

MEDICARE: DAVID RAY WALSWORTH

MEDICARE: DAVID RAY WALSWORTH
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1619854908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID RAY WALSWORTH
Provider Business Mailing Address
First Line : 9045 DUPONT PL
Second Line :
City : WELLINGTON
State : FL
Zip : 33414-6473
Country : US
Telephone Number : 786-712-6020
Fax Number :
Provider Business Practice Location Address
First Line : 3185 BOUTWELL RD
Second Line :
City : LAKE WORTH BEACH
State : FL
Zip : 33461-2610
Country : US
Telephone Number : 561-786-8094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2025
Last Update Date : 08/19/2025

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