Provider Demographics
NPI:1487807996
Name:WALTERS, KATHLEEN ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:7905 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-625-4055
Mailing Address - Fax:718-625-4702
Practice Address - Street 1:7905 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4001
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:718-625-4702
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067538-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical