Provider Demographics
NPI:1952670192
Name:WALSH, JOSEPH WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:WALSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3061
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93586-0061
Mailing Address - Country:US
Mailing Address - Phone:661-524-4752
Mailing Address - Fax:661-952-5616
Practice Address - Street 1:43301 DIVISION ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4647
Practice Address - Country:US
Practice Address - Phone:661-524-4752
Practice Address - Fax:661-952-5616
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical