MEDICARE: MRS. MICHELE A WALSH LCSW

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	1041C0700X	Clinical Social Worker	44SC06370600	NJ

General Provider Information

NPI Number	:	1972335420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE A WALSH LCSW

Provider Business Mailing Address
First Line	:	83 SPRING ST STE 303
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-2080
Country	:	US
Telephone Number	:	973-289-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 SPRING ST STE 303
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-2080
Country	:	US
Telephone Number	:	973-840-1850
Fax Number	:	973-383-0256

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

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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