Provider Demographics
NPI:1013225390
Name:WALSH, JAMIE (LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254B MOUNTAIN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2413
Mailing Address - Country:US
Mailing Address - Phone:908-578-0331
Mailing Address - Fax:
Practice Address - Street 1:39C NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2745
Practice Address - Country:US
Practice Address - Phone:908-979-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054309001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical