Individual
DR. KENNETH S. WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH,D.
Contact information
Practice address
15 FARONE DR APT B11, ONEONTA, NY 13820-1337
(607) 267-7480
Mailing address
15 FARONE DR, APT B-11, ONEONTA, NY 13820-1316
(607) 267-7480
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS1102
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098303
ANTHEM LEGACY NUMBER
ME
05
—
403260099
—
ME
Enumeration date
06/14/2006
Last updated
07/15/2009
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