Provider Demographics
NPI:1669600169
Name:WALSH, TIMOTHY PETER (LCSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PETER
Last Name:WALSH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 MARCON BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-9521
Mailing Address - Country:US
Mailing Address - Phone:610-266-0610
Mailing Address - Fax:
Practice Address - Street 1:961 MARCON BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-9521
Practice Address - Country:US
Practice Address - Phone:610-266-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical