Provider Demographics
NPI:1538721071
Name:WALTERS, DAWN M (LMSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BURDETT AVENUE
Mailing Address - Street 2:SAMARITAN BEHAVIORAL HEALTH
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2215 BURDETT AVENUE
Practice Address - Street 2:SAMARITAN BEHAVIORAL HEALTH
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 273R00000X
NY105904104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist
No273R00000XHospital UnitsPsychiatric Unit