Provider Demographics
NPI:1508003054
Name:WALSH, EDWARD D (MSW, LMSW,CASAC/CADC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:WALSH
Suffix:
Gender:M
Credentials:MSW, LMSW,CASAC/CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 W 58TH ST STE 508
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1819
Mailing Address - Country:US
Mailing Address - Phone:917-862-0240
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 508
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1819
Practice Address - Country:US
Practice Address - Phone:917-862-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8064101YA0400X
NY070757104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)