Provider Demographics
NPI:1851082184
Name:WALKER, JR., MARC L JR
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:L
Last Name:WALKER, JR.
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 BEACON ST BROOKLINE
Mailing Address - Street 2:#655
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02446
Mailing Address - Country:US
Mailing Address - Phone:202-904-4424
Mailing Address - Fax:
Practice Address - Street 1:4 GLENWAY STREET
Practice Address - Street 2:APT 3 UNIT 5
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-0212
Practice Address - Country:US
Practice Address - Phone:202-904-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator