Provider Demographics
NPI:1477697647
Name:WALSH, SUSAN ELEANOR (BS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELEANOR
Last Name:WALSH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 DEEP CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-5002
Mailing Address - Country:US
Mailing Address - Phone:330-467-6504
Mailing Address - Fax:
Practice Address - Street 1:41 E ERIE ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3947
Practice Address - Country:US
Practice Address - Phone:440-358-7370
Practice Address - Fax:440-358-7373
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0021321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker