Provider Demographics
NPI:1265483549
Name:WALTERS, CHERYL (MS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 CHARTER LANE
Mailing Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5896
Mailing Address - Country:US
Mailing Address - Phone:717-394-6688
Mailing Address - Fax:717-394-6804
Practice Address - Street 1:1848 CHARTER LANE
Practice Address - Street 2:LIFE MANAGEMENT ASSOCIATES
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5896
Practice Address - Country:US
Practice Address - Phone:717-394-6688
Practice Address - Fax:717-394-6804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004632L103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01679001OtherCAPITAL BLUE CROSS
PA188837OtherVALUE OPTIONS