Provider Demographics
NPI:1386941151
Name:WALSH, PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
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 1:385 HARBOR BLVD
Mailing Address - Street 2:SUITE 230-A
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2351
Mailing Address - Country:US
Mailing Address - Phone:850-460-8977
Mailing Address - Fax:
Practice Address - Street 1:385 HARBOR BLVD
Practice Address - Street 2:SUITE 230-A
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2351
Practice Address - Country:US
Practice Address - Phone:850-460-8977
Practice Address - Fax:850-460-8978
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 100661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 10066OtherSTATE LICENSE