Provider Demographics
NPI:1598844722
Name:PELZ-WALSH, WILLIAM (MA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PELZ-WALSH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7128
Mailing Address - Country:US
Mailing Address - Phone:802-258-3914
Mailing Address - Fax:802-258-3914
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7128
Practice Address - Country:US
Practice Address - Phone:802-258-3914
Practice Address - Fax:802-258-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006730Medicaid