Provider Demographics
NPI:1710123146
Name:WALSH, CAROLYN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:17 W MERRICK RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3826
Mailing Address - Country:US
Mailing Address - Phone:516-378-2992
Mailing Address - Fax:516-378-0348
Practice Address - Street 1:17 W MERRICK RD
Practice Address - Street 2:UNIT 1
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3826
Practice Address - Country:US
Practice Address - Phone:516-378-2992
Practice Address - Fax:516-378-0348
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker