Provider Demographics
NPI:1164679635
Name:WALSH, CONSTANCE LOUISE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:LOUISE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 PALISADE AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6213
Mailing Address - Country:US
Mailing Address - Phone:718-543-0502
Mailing Address - Fax:
Practice Address - Street 1:5050 ISELIN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2915
Practice Address - Country:US
Practice Address - Phone:718-549-6700
Practice Address - Fax:718-796-4614
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist