Provider Demographics
NPI:1538741756
Name:WALTERS, KATIE M
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BLAKE ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02136-6003
Mailing Address - Country:US
Mailing Address - Phone:281-202-8779
Mailing Address - Fax:
Practice Address - Street 1:11 BLAKE ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02136-6003
Practice Address - Country:US
Practice Address - Phone:281-202-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical