Provider Demographics
NPI:1053087775
Name:WALTERS, PENNY SUE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26916 SILOAM RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1292
Mailing Address - Country:US
Mailing Address - Phone:410-603-2807
Mailing Address - Fax:
Practice Address - Street 1:26916 SILOAM RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1292
Practice Address - Country:US
Practice Address - Phone:410-603-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty