Provider Demographics
NPI:1376551291
Name:POLK, WALTER EARL JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EARL
Last Name:POLK
Suffix:JR
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:HARFORD PSYCHOLOGICAL SERVICES P.A.
Mailing Address - Street 2:2945 EMMORTON ROAD, P.O. BOX 322
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009
Mailing Address - Country:US
Mailing Address - Phone:410-569-0007
Mailing Address - Fax:410-569-3738
Practice Address - Street 1:543 COUNTRY RIDGE CIRCLE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-569-0007
Practice Address - Fax:410-569-3738
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1526103TC0700X
MD01526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD189931700Medicaid