Provider Demographics
NPI:1356905608
Name:WALSH, SYDNEY LAYNE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LAYNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8502
Mailing Address - Country:US
Mailing Address - Phone:502-709-5240
Mailing Address - Fax:
Practice Address - Street 1:6435 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8502
Practice Address - Country:US
Practice Address - Phone:502-709-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-53494103K00000X
RBT-19-80156106S00000X
KY274204103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-21-53494OtherBCBA CERTIFICATE
RBT-19-80156OtherRBT