Provider Demographics
NPI:1770696940
Name:WALSH, PHYLLIS ANN (LMSW ACSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS ANN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 PERCH POND ROAD
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:NY
Mailing Address - Zip Code:13813-1127
Mailing Address - Country:US
Mailing Address - Phone:607-693-2682
Mailing Address - Fax:
Practice Address - Street 1:81 E MAIN ST APT A
Practice Address - Street 2:FAMILIES IN HARMONY
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-3203
Practice Address - Country:US
Practice Address - Phone:607-639-2300
Practice Address - Fax:607-693-2692
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0725081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical