Provider Demographics
NPI:1962443259
Name:WALSH, PATRICIA SUE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:SUE
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 1:1941 BISHOP LN
Mailing Address - Street 2:SUITE 707
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1937
Mailing Address - Country:US
Mailing Address - Phone:502-459-3774
Mailing Address - Fax:502-451-8374
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:SUITE 707
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1937
Practice Address - Country:US
Practice Address - Phone:502-459-3774
Practice Address - Fax:502-451-8374
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYHUKY0531OtherHUMANA
KY070849OtherVALUEOPTIONS
KY057862000OtherMAGELLAN
KYCSW0042Medicare ID - Type UnspecifiedMEDICARE