Provider Demographics
NPI:1184960817
Name:WALDEN, JEFFREY BRIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:WALDEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 GONDOLIER DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-6472
Mailing Address - Country:US
Mailing Address - Phone:252-633-4279
Mailing Address - Fax:
Practice Address - Street 1:1304C COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2212
Practice Address - Country:US
Practice Address - Phone:252-637-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6819103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist