Provider Demographics
NPI:1427185891
Name:KING, WALTER COURTLANDT (LICSW)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:COURTLANDT
Last Name:KING
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 PLAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2147
Mailing Address - Country:US
Mailing Address - Phone:781-834-7433
Mailing Address - Fax:781-834-7458
Practice Address - Street 1:769 PLAIN ST STE I
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2147
Practice Address - Country:US
Practice Address - Phone:781-834-7433
Practice Address - Fax:781-834-7458
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10120241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical