Provider Demographics
NPI:1962657619
Name:WALSH, MARY CASWELL (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CASWELL
Last Name:WALSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-2068
Mailing Address - Country:US
Mailing Address - Phone:510-292-9537
Mailing Address - Fax:
Practice Address - Street 1:822 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-2068
Practice Address - Country:US
Practice Address - Phone:510-292-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46303106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist