Provider Demographics
NPI:1043411937
Name:WALSH, ELIZABETH W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:W
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:GOULDSBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04607-3339
Mailing Address - Country:US
Mailing Address - Phone:207-255-6786
Mailing Address - Fax:207-255-6782
Practice Address - Street 1:UPPER COURT STREET
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-6786
Practice Address - Fax:207-255-6782
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC94491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical