Provider Demographics
NPI:1083853881
Name:WALTERMYER, MICHAL A (BS)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:A
Last Name:WALTERMYER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5773
Mailing Address - Country:US
Mailing Address - Phone:717-676-7743
Mailing Address - Fax:
Practice Address - Street 1:9730 HEALTHWAY DRIVE
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT - BERLIN HEALTH CT.
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MD705371101Medicaid