Individual
SHANNON MAE WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2001 MARCUS AVE STE E128, NEW HYDE PARK, NY 11042-1000
(516) 390-3525
(516) 396-2195
Mailing address
2001 MARCUS AVE STE E128, NEW HYDE PARK, NY 11042-1000
(516) 390-3525
(516) 396-2195
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
025427
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025427
PSYCHOLOGY LICENSE
NY
Enumeration date
12/15/2022
Last updated
12/15/2022
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