Provider Demographics
NPI:1598918245
Name:WALSH, ANNA LYNN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA LYNN
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GEORGANN RD
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3225
Mailing Address - Country:US
Mailing Address - Phone:631-902-3854
Mailing Address - Fax:631-286-6955
Practice Address - Street 1:380 MILL RD
Practice Address - Street 2:380 MILL RD.
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-2063
Practice Address - Country:US
Practice Address - Phone:631-902-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical