MEDICARE: DR. JOSEPH WILLIAM WALSH PH.D.

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	PSY14849	CA

General Provider Information

NPI Number	:	1952670192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM WALSH PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 3061
Second Line	:
City	:	QUARTZ HILL
State	:	CA
Zip	:	93586-0061
Country	:	US
Telephone Number	:	661-524-4752
Fax Number	:	661-952-5616

Provider Business Practice Location Address
First Line	:	43301 DIVISION ST
Second Line	:	SUITE 104
City	:	LANCASTER
State	:	CA
Zip	:	93535-4647
Country	:	US
Telephone Number	:	661-524-4752
Fax Number	:	661-952-5616

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

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/16/2011

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