Provider Demographics
NPI:1922161058
Name:WALSH, PAMELA T (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:T
Last Name:WALSH
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 1:8704 S CONSTANCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2746
Mailing Address - Country:US
Mailing Address - Phone:773-734-4033
Mailing Address - Fax:773-731-9695
Practice Address - Street 1:8704 S CONSTANCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2746
Practice Address - Country:US
Practice Address - Phone:773-734-4033
Practice Address - Fax:773-731-9695
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical