Provider Demographics
NPI:1558578781
Name:WALSH, RICHARD W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:WALSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:W
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:338 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1510
Mailing Address - Country:US
Mailing Address - Phone:207-622-3036
Mailing Address - Fax:207-547-4592
Practice Address - Street 1:338 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1510
Practice Address - Country:US
Practice Address - Phone:207-622-3036
Practice Address - Fax:207-547-4592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC69261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027718Medicaid
MEWAMM8780Medicare ID - Type Unspecified
ME027718Medicaid