Provider Demographics
NPI:1659521508
Name:WALTER, HEIDI (MED)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DARLING ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1516
Mailing Address - Country:US
Mailing Address - Phone:413-543-1094
Mailing Address - Fax:413-732-8194
Practice Address - Street 1:40 ELEANOR RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-827-0519
Practice Address - Fax:413-732-8194
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)