Provider Demographics
NPI:1194054478
Name:WALSH, KARA (LCSW)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
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 1:2828 JASMINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-2818
Mailing Address - Country:US
Mailing Address - Phone:508-259-8866
Mailing Address - Fax:508-259-8866
Practice Address - Street 1:2828 JASMINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-2818
Practice Address - Country:US
Practice Address - Phone:508-259-8866
Practice Address - Fax:508-259-8866
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2017-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2161311041C0700X
COCSW.099230721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200445Medicaid