Provider Demographics
NPI:1972030013
Name:WALKER, ELIZABETH E (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1102
Mailing Address - Country:US
Mailing Address - Phone:207-209-4043
Mailing Address - Fax:
Practice Address - Street 1:4 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1102
Practice Address - Country:US
Practice Address - Phone:207-209-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health