Provider Demographics
NPI:1134650757
Name:WALTER, JEZEBEL (LMSW)
Entity Type:Individual
Prefix:
First Name:JEZEBEL
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 HERITAGE HLS UNIT B
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1738
Mailing Address - Country:US
Mailing Address - Phone:917-576-8877
Mailing Address - Fax:
Practice Address - Street 1:78 MAIN STREET
Practice Address - Street 2:FAMILY SERVICES OF WESTCHESTER - ECHO HILLS
Practice Address - City:HASTINGS-ON-HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706
Practice Address - Country:US
Practice Address - Phone:914-274-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054433104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker