Provider Demographics
NPI:1710903489
Name:WALSH, BEVERLY BECKWITH (LCSW-C; LICSW; PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:BECKWITH
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW-C; LICSW; PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SHEPARD WAY NW
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1719
Mailing Address - Country:US
Mailing Address - Phone:410-960-8596
Mailing Address - Fax:
Practice Address - Street 1:321 SHEPARD WAY NW
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1719
Practice Address - Country:US
Practice Address - Phone:410-960-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD086801041C0700X
WALW 601817691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
526SMedicare PIN