Provider Demographics
NPI:1609911189
Name:WALSH, BONNIE J (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:J
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 HAWTHORNE LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4714
Mailing Address - Country:US
Mailing Address - Phone:860-970-8126
Mailing Address - Fax:
Practice Address - Street 1:1281 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2410
Practice Address - Country:US
Practice Address - Phone:860-970-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004266591Medicaid
CT004266591Medicaid