Provider Demographics
NPI:1003944224
Name:WALSH, DEBORAH
Entity Type:Individual
Prefix:
First Name:DEBORAH
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 1:320 E MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3177
Mailing Address - Country:US
Mailing Address - Phone:330-296-3700
Mailing Address - Fax:330-298-1460
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3177
Practice Address - Country:US
Practice Address - Phone:330-296-3700
Practice Address - Fax:330-296-1480
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4928103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling