Provider Demographics
NPI:1487267183
Name:WALSH, ANDREW (LSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COLUMBIA TPKE STE 305
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2145
Mailing Address - Country:US
Mailing Address - Phone:973-978-5502
Mailing Address - Fax:
Practice Address - Street 1:147 COLUMBIA TPKE STE 305
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2145
Practice Address - Country:US
Practice Address - Phone:973-978-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06432800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional