Provider Demographics
NPI:1578976148
Name:WALSH, REGINA (LAC)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HOLMEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4102
Mailing Address - Country:US
Mailing Address - Phone:914-234-6068
Mailing Address - Fax:
Practice Address - Street 1:8 HOLMEWOOD LN
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4102
Practice Address - Country:US
Practice Address - Phone:914-234-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist