Provider Demographics
NPI:1053328567
Name:WALSH, JOHN ANTHONY JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:WALSH
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7274
Mailing Address - Street 2:401 GILFORD AVE., #1C
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-7274
Mailing Address - Country:US
Mailing Address - Phone:603-528-2307
Mailing Address - Fax:603-528-2257
Practice Address - Street 1:401 GILFORD AVE # 1C
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-7500
Practice Address - Country:US
Practice Address - Phone:603-528-2307
Practice Address - Fax:603-528-2257
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80622250Medicaid
NH80622250Medicaid