Provider Demographics
NPI:1235178740
Name:WALSH, RUSSELL A (PHD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:WALSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 WILLIAM FLYNN HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1439
Mailing Address - Country:US
Mailing Address - Phone:412-371-7330
Mailing Address - Fax:412-242-4732
Practice Address - Street 1:4284 WILLIAM FLYNN HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1439
Practice Address - Country:US
Practice Address - Phone:412-371-7330
Practice Address - Fax:412-242-4732
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008249L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA464910OtherVALUEOPTIONS
PA276894OtherHIGHMARK BC BS
PAP39771Medicare UPIN