Provider Demographics
NPI:1740405893
Name:WALSH, PIPER ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PIPER
Middle Name:ANN
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 AVENIDA DOMINGUEZ
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3412
Mailing Address - Country:US
Mailing Address - Phone:949-370-4726
Mailing Address - Fax:949-492-3019
Practice Address - Street 1:655 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2809
Practice Address - Country:US
Practice Address - Phone:949-370-4726
Practice Address - Fax:949-661-9041
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical