Provider Demographics
NPI:1497811426
Name:WALKER, LAURIE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:1 HONEOYE COMMONS
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-0663
Mailing Address - Country:US
Mailing Address - Phone:585-229-7083
Mailing Address - Fax:585-229-7150
Practice Address - Street 1:1 HONEOYE COMMONS
Practice Address - Street 2:
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-0663
Practice Address - Country:US
Practice Address - Phone:585-229-7083
Practice Address - Fax:585-229-7150
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0415661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34612Medicare UPIN
NYCC6653Medicare ID - Type Unspecified