Provider Demographics
NPI:1790841963
Name:WALSH, MARIANNE (MSW, M A)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:MSW, M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-0942
Mailing Address - Country:US
Mailing Address - Phone:845-368-3440
Mailing Address - Fax:
Practice Address - Street 1:66 MILTON RD
Practice Address - Street 2:APARTMENT G12
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3850
Practice Address - Country:US
Practice Address - Phone:914-584-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLCSW SC06014101YM0800X
NYLCSW R033920-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY167974OtherMENTAL HEALTH NETWORK
NY135522OtherVALUE OPTIONS MHS PROVIDE
NYP1296544OtherOXFORD PROVIDER
NY0006950OtherGHI PIN#
NY72378297OtherUNITED HEALTHCARE UID
NY0006950OtherGHI PIN#