Provider Demographics
NPI:1093020166
Name:WALDEN, JOHN EUGENE (S PSYS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EUGENE
Last Name:WALDEN
Suffix:
Gender:M
Credentials:S PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 US 20
Mailing Address - Street 2:
Mailing Address - City:NASSAU
Mailing Address - State:NY
Mailing Address - Zip Code:12123-1815
Mailing Address - Country:US
Mailing Address - Phone:518-766-2391
Mailing Address - Fax:
Practice Address - Street 1:2610 US 20
Practice Address - Street 2:
Practice Address - City:NASSAU
Practice Address - State:NY
Practice Address - Zip Code:12123-1815
Practice Address - Country:US
Practice Address - Phone:518-766-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool