Provider Demographics
NPI:1740458850
Name:WALSH, JULIE BETH (LCDP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:BETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-8518
Mailing Address - Country:US
Mailing Address - Phone:401-736-3899
Mailing Address - Fax:401-615-9540
Practice Address - Street 1:1 JAMES P. MURPHY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-615-0648
Practice Address - Fax:401-615-9540
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00402172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker