Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 102654 | NY |
NPI | 1003307745 |
---|---|
Provider Name | Mr. Joseph Charles Walsh III |
First Address | Jackson Heights, NY 11372-7920 |
Second Address | Jackson Heights, NY 11372-7920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2018 |
Last Update Date | 29/05/2018 |