Provider Demographics
NPI:1205817566
Name:WALSH, SARAH M (MSW, LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 JONES RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5225
Mailing Address - Country:US
Mailing Address - Phone:607-785-6326
Mailing Address - Fax:607-729-1858
Practice Address - Street 1:257 MAIN ST
Practice Address - Street 2:FAMILY AND CHILDRENS SOCIETY
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2522
Practice Address - Country:US
Practice Address - Phone:607-729-6206
Practice Address - Fax:607-729-1858
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042647-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11325586OtherCAQH
NYP95454Medicare UPIN