Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1134542814 |
---|---|
Provider Name | Carmella Walker |
First Address | Johnstown, PA 15901-1628 |
Second Address | Johnstown, PA 15901-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2014 |
Last Update Date | 30/01/2014 |