Provider Demographics
NPI:1114317203
Name:WALLSH, EMILY (LMHC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALLSH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BRYN MAWR DR
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3101
Mailing Address - Country:US
Mailing Address - Phone:802-558-6834
Mailing Address - Fax:
Practice Address - Street 1:23 BRYN MAWR DR
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3101
Practice Address - Country:US
Practice Address - Phone:518-300-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007344101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health