Provider Demographics
NPI:1972685030
Name:WALTON, CATHY (LPC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2213
Mailing Address - Country:US
Mailing Address - Phone:860-823-1399
Mailing Address - Fax:
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:STE 314
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-823-1399
Practice Address - Fax:860-823-1170
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD80821Medicare UPIN