Provider Information for 1679074074
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LOUIS C WALTHALL, LCSWR, CASAC
Organization Subpart: NO
NPI: 1679074074
Last Updated: 2018-02-22
Certification Date:
Certification Date:
Details
Name | Value | ||||||||||||
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NPI | 1679074074 | ||||||||||||
Enumeration Date | 2018-02-22 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: LOUIS C WALTHALL LCSWR, CASAC Title: LICENSED CLINICAL SOCIAL WORKER Phone: 6314915720 | ||||||||||||
Mailing Address | 10 LODGE PL WEST BABYLON, NY 11704-1608 United States Phone: 631-491-5817 | Fax: | ||||||||||||
Primary Practice Address | 10 LODGE PL WEST BABYLON, NY 11704-1608 United States Phone: 631-491-5720 | Fax: | ||||||||||||
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