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Individual
MR. MICHAEL PATRICK WALL
Active
Individual
MR. MICHAEL PATRICK WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSWC
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSWC07449
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1QV10MP2752664001
BCBS MD
MD
Enumeration date
02/07/2007
Last updated
07/08/2007
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