Provider Demographics
NPI:1952633224
Name:WALSH, JENNIFER ROSE (PMHNP-BC, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PMHNP-BC, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1845
Mailing Address - Country:US
Mailing Address - Phone:914-574-4535
Mailing Address - Fax:914-574-4535
Practice Address - Street 1:180 S BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1845
Practice Address - Country:US
Practice Address - Phone:914-574-4535
Practice Address - Fax:914-574-4535
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420952-1363LW0102X
NJ26NJ00334400363LW0102X
NY404582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health