Provider Demographics
NPI:1346022720
Name:WALSH, PETER SIMON
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:SIMON
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FLORIDA AVE NE APT 929
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-8118
Mailing Address - Country:US
Mailing Address - Phone:310-703-2566
Mailing Address - Fax:
Practice Address - Street 1:1255 UNION ST NE FL 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7042
Practice Address - Country:US
Practice Address - Phone:310-703-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional