Provider Demographics
NPI:1710627823
Name:WALSH, CARLYN G (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLYN
Middle Name:G
Last Name:WALSH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOCELYN PL
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1299
Mailing Address - Country:US
Mailing Address - Phone:201-704-4637
Mailing Address - Fax:
Practice Address - Street 1:600 VALLEY RD STE 19
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3551
Practice Address - Country:US
Practice Address - Phone:201-704-4637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL01483800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty