Provider Demographics
NPI:1447537089
Name:WALTER, LOIS A
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:A
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:NARDONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:519 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3374
Mailing Address - Country:US
Mailing Address - Phone:908-347-6061
Mailing Address - Fax:
Practice Address - Street 1:519 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3374
Practice Address - Country:US
Practice Address - Phone:908-347-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05829700102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst