Provider Demographics
NPI:1174765440
Name:WALSH, C KAY (MS, ATR)
Entity type:Individual
Prefix:
First Name:C
Middle Name:KAY
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CUMMINGS CTR STE 266T
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6172
Mailing Address - Country:US
Mailing Address - Phone:978-921-1190
Mailing Address - Fax:978-927-3724
Practice Address - Street 1:800 CUMMINGS CTR STE 266T
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6172
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:978-927-3724
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)