Provider Demographics
NPI:1144593773
Name:WALSH, EMILY MARY NELSON (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MARY NELSON
Last Name:WALSH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03821-1604
Mailing Address - Country:US
Mailing Address - Phone:603-836-0393
Mailing Address - Fax:
Practice Address - Street 1:90 WASHINGTON ST STE 301B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3744
Practice Address - Country:US
Practice Address - Phone:603-836-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24821041C0700X
NCC0085671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical