Provider Demographics
NPI:1225539265
Name:WALKER, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:ELIZABETH
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:202 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13493-2419
Mailing Address - Country:US
Mailing Address - Phone:716-255-1190
Mailing Address - Fax:
Practice Address - Street 1:202 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13493-2419
Practice Address - Country:US
Practice Address - Phone:716-255-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0949571041C0700X
NY10-0999-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker