Provider Demographics
NPI:1093083370
Name:WALTER, ABBE LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ABBE
Middle Name:LEIGH
Last Name:WALTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5425
Mailing Address - Country:US
Mailing Address - Phone:347-515-3886
Mailing Address - Fax:
Practice Address - Street 1:58 PINE ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5425
Practice Address - Country:US
Practice Address - Phone:347-515-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical