Provider Demographics
NPI:1710727516
Name:WALTER, JOSIE-YANIQUE
Entity type:Individual
Prefix:
First Name:JOSIE-YANIQUE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33415-1261
Mailing Address - Country:US
Mailing Address - Phone:561-768-1378
Mailing Address - Fax:
Practice Address - Street 1:5425 CLUB CIR
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:FL
Practice Address - Zip Code:33415-1261
Practice Address - Country:US
Practice Address - Phone:561-768-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool