Provider Demographics
NPI:1578997078
Name:WALSH, SYDNEY A (PHD)
Entity Type:Individual
Prefix:MS
First Name:SYDNEY
Middle Name:A
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S TROY ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2720
Mailing Address - Country:US
Mailing Address - Phone:248-854-8279
Mailing Address - Fax:
Practice Address - Street 1:317 E 11 MILE RD
Practice Address - Street 2:INNER DOOR CENTER
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2735
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016444103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral