Provider Demographics
NPI:1972865962
Name:WALTHER, NANCY M (MA, MSW, LCSW, LCADC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:WALTHER
Suffix:
Gender:F
Credentials:MA, MSW, LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 UPPER MONTCLAIR PLZ
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1343
Mailing Address - Country:US
Mailing Address - Phone:201-540-8168
Mailing Address - Fax:201-625-0143
Practice Address - Street 1:51 UPPER MONTCLAIR PLZ
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:201-704-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05503800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health