Provider Demographics
NPI:1952066557
Name:WALKER, KATRINA DENISE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:DENISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SOUTHWICK ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2024
Mailing Address - Country:US
Mailing Address - Phone:413-786-6410
Mailing Address - Fax:413-789-9623
Practice Address - Street 1:30 SOUTHWICK ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2024
Practice Address - Country:US
Practice Address - Phone:413-786-6410
Practice Address - Fax:413-789-9623
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN96841164W00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse