Provider Demographics
NPI:1700134020
Name:WALLWORK, ERNEST (PHD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:WALLWORK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 DAVENPORT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2116
Mailing Address - Country:US
Mailing Address - Phone:202-244-7919
Mailing Address - Fax:
Practice Address - Street 1:3021 DAVENPORT ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2116
Practice Address - Country:US
Practice Address - Phone:202-244-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000175-1101YM0800X
DC74101YP2500X
NY000038102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional