Provider Demographics
NPI:1225553357
Name:WALKER, JANELLE DELAINE
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:DELAINE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANELLE
Other - Middle Name:DELAINE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:1510 ARCHER RD APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5834
Mailing Address - Country:US
Mailing Address - Phone:646-315-0976
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1022
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:718-886-8694
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician