Provider Demographics
NPI:1417292681
Name:WALSH, EMILY M (LCAT, ATR)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCAT, ATR
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:MILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT, ATR-BC
Mailing Address - Street 1:408 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5220
Mailing Address - Country:US
Mailing Address - Phone:607-273-0886
Mailing Address - Fax:
Practice Address - Street 1:408 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5220
Practice Address - Country:US
Practice Address - Phone:607-273-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001526101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid