Provider Demographics
NPI:1841417763
Name:WALDEN, JOHN (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WALDEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RICHMAN PLZ APT 17D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6522
Mailing Address - Country:US
Mailing Address - Phone:917-434-5589
Mailing Address - Fax:
Practice Address - Street 1:2976 NORTHERN BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2829
Practice Address - Country:US
Practice Address - Phone:212-691-7554
Practice Address - Fax:718-220-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072864104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker