Provider Demographics
NPI:1295213130
Name:WALSH, TESS W (MA, LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:TESS
Middle Name:W
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 JORDAN ROAD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152
Mailing Address - Country:US
Mailing Address - Phone:315-685-5157
Mailing Address - Fax:
Practice Address - Street 1:4361 JORDAN RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9334
Practice Address - Country:US
Practice Address - Phone:315-857-5971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1014161041C0700X
NY0906471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical