Provider Demographics
NPI:1366035164
Name:WALZAK, EMILY M
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:WALZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 HAMPTON MDWS
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1815
Mailing Address - Country:US
Mailing Address - Phone:603-553-0915
Mailing Address - Fax:
Practice Address - Street 1:74 HAMPTON MDWS
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1815
Practice Address - Country:US
Practice Address - Phone:603-553-0915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MALCSW229626104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker