Provider Demographics
NPI:1407439821
Name:WALSH, THOMAS ALBERT II (ME)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALBERT
Last Name:WALSH
Suffix:II
Gender:M
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NORMAN ST APT 303
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3356
Mailing Address - Country:US
Mailing Address - Phone:978-935-6565
Mailing Address - Fax:
Practice Address - Street 1:24 NORMAN ST APT 303
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3356
Practice Address - Country:US
Practice Address - Phone:978-935-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53180639101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor