| Louis C Walthall, Lcswr, Casac | |
|
10 Lodge Pl West Babylon NY 11704-1608 | |
| (631) 491-5720 | |
| Not Available |
| Full Name | Louis C Walthall, Lcswr, Casac |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10 Lodge Pl, West Babylon, New York |
| Authorized Official Name and Position | Louis C Walthall (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6314915720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Louis C Walthall, Lcswr, Casac 10 Lodge Pl West Babylon NY 11704-1608 Ph: (631) 491-5817 | Louis C Walthall, Lcswr, Casac 10 Lodge Pl West Babylon NY 11704-1608 Ph: (631) 491-5720 |
| NPI Number | 1679074074 |
|---|---|
| Provider Enumeration Date | 02/22/2018 |
| Last Update Date | 02/22/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679074074 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 9438 (New York) | Secondary |
| 1041C0700X | Social Worker - Clinical | 051661 (New York) | Primary |
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