Provider Demographics
NPI:1316376445
Name:WALSH, BARENT (PHD)
Entity Type:Individual
Prefix:
First Name:BARENT
Middle Name:
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 1:4 MANN STREET
Mailing Address - Street 2:THE BRIDGE OF CENTRAL MASSACHUSETTS
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602
Mailing Address - Country:US
Mailing Address - Phone:508-755-0333
Mailing Address - Fax:508-755-2191
Practice Address - Street 1:4 MANN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3414
Practice Address - Country:US
Practice Address - Phone:508-755-0333
Practice Address - Fax:508-755-2191
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical