Provider Demographics
NPI:1487105078
Name:WALSH, KILYA INDIA
Entity type:Individual
Prefix:
First Name:KILYA
Middle Name:INDIA
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KILYA
Other - Middle Name:INDIA
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:6 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:NY
Mailing Address - Zip Code:12775-8220
Mailing Address - Country:US
Mailing Address - Phone:845-796-6197
Mailing Address - Fax:
Practice Address - Street 1:3 COMMERCIAL PL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5306
Practice Address - Country:US
Practice Address - Phone:845-220-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30724101YA0400X
NY106031104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106031OtherLMSW