Provider Demographics
NPI:1114745221
Name:WALTER, CARON (PHD)
Entity type:Individual
Prefix:
First Name:CARON
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARON
Other - Middle Name:
Other - Last Name:HEIGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16504 GRANDE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1916
Mailing Address - Country:US
Mailing Address - Phone:703-357-7599
Mailing Address - Fax:
Practice Address - Street 1:16504 GRANDE VISTA DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-1916
Practice Address - Country:US
Practice Address - Phone:703-357-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical