Provider Demographics
NPI:1093248767
Name:WALKER, TANYA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2304
Mailing Address - Country:US
Mailing Address - Phone:201-906-6633
Mailing Address - Fax:
Practice Address - Street 1:429 JOHN F KENNEDY WAY
Practice Address - Street 2:STE. 235
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2118
Practice Address - Country:US
Practice Address - Phone:609-871-4442
Practice Address - Fax:609-835-6569
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054778001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical