Provider Demographics
NPI:1568793032
Name:WALKER, MARY-EILEEN (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY-EILEEN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 70
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305
Mailing Address - Country:US
Mailing Address - Phone:954-463-2723
Mailing Address - Fax:954-463-1687
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 70
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:954-463-2723
Practice Address - Fax:954-463-1687
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1622101YM0800X
FLMT1260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist