Provider Demographics
NPI:1609088582
Name:WALSH, PATRICIA ELLEN (LADC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:WALSH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ELLEN
Other - Last Name:LAMONDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:11 CIRCLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905
Mailing Address - Country:US
Mailing Address - Phone:603-447-4877
Mailing Address - Fax:
Practice Address - Street 1:11 CIRCLE AVENUE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905
Practice Address - Country:US
Practice Address - Phone:603-447-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0609OtherLADC