Provider Demographics
NPI:1760923973
Name:WALTERS, MARY (MA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 13TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5104
Mailing Address - Country:US
Mailing Address - Phone:917-435-5520
Mailing Address - Fax:
Practice Address - Street 1:ALMA
Practice Address - Street 2:397 BRIDGE ST
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1120
Practice Address - Country:US
Practice Address - Phone:917-397-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health