Provider Demographics
NPI:1093296360
Name:THAMSTEN, WALTER MARIANO (LMHC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MARIANO
Last Name:THAMSTEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 RENAISSANCE COMMONS BLVD APT 230
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8283
Mailing Address - Country:US
Mailing Address - Phone:954-232-4695
Mailing Address - Fax:
Practice Address - Street 1:200 CONGRESS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4618
Practice Address - Country:US
Practice Address - Phone:954-232-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health