Provider Demographics
NPI:1225887284
Name:WALSH, LUCY ANNA (MA)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:ANNA
Last Name:WALSH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 W END AVE APT 16C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6921
Mailing Address - Country:US
Mailing Address - Phone:310-359-5084
Mailing Address - Fax:
Practice Address - Street 1:158 W 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4919
Practice Address - Country:US
Practice Address - Phone:332-243-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program