Provider Demographics
NPI:1366514283
Name:WALTERS, COLLEEN A (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROWN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3617
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:31 W BROAD ST FL 3
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1615
Practice Address - Country:US
Practice Address - Phone:845-429-4499
Practice Address - Fax:845-429-5185
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0760891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical