Provider Demographics
NPI:1831323146
Name:WALCOTT, TARYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TARYN
Middle Name:
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:WALCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:800 POLY PL
Mailing Address - Street 2:RM 9-103
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-836-6600
Mailing Address - Fax:
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:RM 9-103
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-836-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72076589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker