Provider Demographics
NPI:1134616519
Name:WALSH, SHARON R
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 SPRUCELAND RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-2359
Mailing Address - Country:US
Mailing Address - Phone:860-272-1026
Mailing Address - Fax:
Practice Address - Street 1:153 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4592
Practice Address - Country:US
Practice Address - Phone:860-253-5020
Practice Address - Fax:860-253-5030
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor