Provider Demographics
NPI:1578647582
Name:WALSH, KATE (LCPC)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GALVIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5108
Mailing Address - Country:US
Mailing Address - Phone:207-329-3945
Mailing Address - Fax:207-781-7882
Practice Address - Street 1:5 FUNDY RD STE 2
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1753
Practice Address - Country:US
Practice Address - Phone:207-329-3945
Practice Address - Fax:207-781-7882
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432150099Medicaid