Provider Demographics
NPI:1578702890
Name:WALSH, MAUREEN VICTORIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:VICTORIA
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 FARMINGTON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1554
Mailing Address - Country:US
Mailing Address - Phone:860-878-9719
Mailing Address - Fax:
Practice Address - Street 1:846 FARMINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1554
Practice Address - Country:US
Practice Address - Phone:860-878-9719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CT002083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist