Provider Demographics
NPI:1003425265
Name:WALSH, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W MAIN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4832
Mailing Address - Country:US
Mailing Address - Phone:732-393-8391
Mailing Address - Fax:732-308-4500
Practice Address - Street 1:303 W MAIN ST STE 350
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4832
Practice Address - Country:US
Practice Address - Phone:732-393-8391
Practice Address - Fax:732-308-4500
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty