Provider Demographics
NPI:1447534664
Name:WALTERS, PATRICIA M (MA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1251 S CEDAR CREST BLVD STE 202A
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6214
Practice Address - Country:US
Practice Address - Phone:610-402-5766
Practice Address - Fax:610-402-5763
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC007304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)