Provider Demographics
NPI:1952539835
Name:WALSH, MICHELLE J (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1500
Mailing Address - Country:US
Mailing Address - Phone:207-370-2837
Mailing Address - Fax:
Practice Address - Street 1:326 WATER ST
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1500
Practice Address - Country:US
Practice Address - Phone:207-370-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173801041C0700X
MELC140171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical