MEDICARE: DR. JOHN PATRICK WALSH PSYD

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	024635	NY

General Provider Information

NPI Number	:	1710622790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PATRICK WALSH PSYD

Provider Business Mailing Address
First Line	:	359 2ND ST APT 1
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2691
Country	:	US
Telephone Number	:	732-579-2875
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 2ND ST APT 1
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-2691
Country	:	US
Telephone Number	:	732-579-2875
Fax Number	:

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

Provider Enumeration Date	:	05/03/2022
Last Update Date	:	05/03/2022

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