Provider Demographics
NPI:1457532186
Name:WALSH, THOMAS J
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:WALSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 BATTERY LN STE 202
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2703
Mailing Address - Country:US
Mailing Address - Phone:301-656-6420
Mailing Address - Fax:301-881-8733
Practice Address - Street 1:4848 BATTERY LN STE 202
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2703
Practice Address - Country:US
Practice Address - Phone:301-656-6420
Practice Address - Fax:301-881-8733
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD70001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical