Provider Demographics
NPI:1295980464
Name:WALSH, AILEEN (LCSWR)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SIMMONS DR N
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1249
Mailing Address - Country:US
Mailing Address - Phone:845-853-9090
Mailing Address - Fax:
Practice Address - Street 1:109 SIMMONS DR N
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1249
Practice Address - Country:US
Practice Address - Phone:845-853-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035553-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03715271Medicaid