Individual
MICHAEL WALTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 HOPPIN ST, SUITE 204, PROVIDENCE, RI 02903-4141
(401) 444-8945
(401) 444-8742
Mailing address
1 HOPPIN ST, SUITE 204, PROVIDENCE, RI 02903-4141
(401) 444-8945
(401) 444-8742
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PS01443
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS01443
PROFESSIONAL LICENSE
RI
Enumeration date
07/08/2014
Last updated
07/08/2014
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