Provider Demographics
NPI:1750864690
Name:WALTER, ELIZABETH DIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANNE
Last Name:WALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAPLE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1732
Mailing Address - Country:US
Mailing Address - Phone:732-539-3571
Mailing Address - Fax:
Practice Address - Street 1:200 MAPLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1732
Practice Address - Country:US
Practice Address - Phone:732-539-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057896001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical