Provider Demographics
NPI:1932755519
Name:WALSH JAMES, ROSERITA RYAN (LCSW, MSW, MA)
Entity Type:Individual
Prefix:MS
First Name:ROSERITA
Middle Name:RYAN
Last Name:WALSH JAMES
Suffix:
Gender:F
Credentials:LCSW, MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11359 S LOTHAIR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4133
Mailing Address - Country:US
Mailing Address - Phone:773-551-7673
Mailing Address - Fax:
Practice Address - Street 1:11359 S LOTHAIR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4133
Practice Address - Country:US
Practice Address - Phone:773-551-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490214211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical