Provider Demographics
NPI:1497073043
Name:WALSH, MEGHAN MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MICHELLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 MAIN ST UNIT 1089
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3438
Mailing Address - Country:US
Mailing Address - Phone:207-591-2957
Mailing Address - Fax:
Practice Address - Street 1:775 MAIN ST UNIT 1089
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3438
Practice Address - Country:US
Practice Address - Phone:207-591-2957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC130821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434923399Medicaid
MEE400171853Medicare PIN
ME002505301Medicare PIN