Provider Demographics
NPI:1568864569
Name:WALCZAK, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:WALCZAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-3265
Mailing Address - Country:US
Mailing Address - Phone:978-212-5023
Mailing Address - Fax:
Practice Address - Street 1:15 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-3265
Practice Address - Country:US
Practice Address - Phone:978-212-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health