Provider Demographics
NPI:1336615004
Name:WALSH, DENISE MARIE (MS, LBS, ICADC, MAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, LBS, ICADC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MONARCH CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2057
Mailing Address - Country:US
Mailing Address - Phone:215-712-2582
Mailing Address - Fax:
Practice Address - Street 1:400 FARM LN STE A
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4740
Practice Address - Country:US
Practice Address - Phone:215-712-2582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8788101YA0400X
103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA47-4621588Medicaid
PA8788Medicaid