Provider Demographics
NPI:1609357862
Name:WALSH-MAGONI, SUSAN (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WALSH-MAGONI
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2518
Mailing Address - Country:US
Mailing Address - Phone:215-287-5671
Mailing Address - Fax:
Practice Address - Street 1:29 SIMPSON LN
Practice Address - Street 2:# 6
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2230
Practice Address - Country:US
Practice Address - Phone:215-287-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical