Provider Demographics
NPI:1477528628
Name:HEALEY, WALTER JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:HEALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RACE POINT ROAD
Mailing Address - Street 2:UNIT B, GOSNOLD-THORNE COUNSELING
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657
Mailing Address - Country:US
Mailing Address - Phone:508-487-2449
Mailing Address - Fax:508-487-1921
Practice Address - Street 1:30 CONWELL ST
Practice Address - Street 2:GOSNOLD THORNE COUNSELING
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1548
Practice Address - Country:US
Practice Address - Phone:508-487-2449
Practice Address - Fax:508-487-1921
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1502162084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5293582OtherAETNA
MA150216OtherTUFTS
MA15512200OtherMAGELLAN
MA3165540Medicaid
MAJ18180OtherBLUE CROSS
MA260037303OtherUNITED HEALTHCARE
MA4383-01OtherPACIFICARE
MA15512200OtherMAGELLAN
MA5293582OtherAETNA