Provider Demographics
NPI:1700135902
Name:WALPOLE, JOAN KATHRYN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:KATHRYN
Last Name:WALPOLE
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 1:70 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3344
Mailing Address - Country:US
Mailing Address - Phone:201-707-1796
Mailing Address - Fax:
Practice Address - Street 1:70 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-3344
Practice Address - Country:US
Practice Address - Phone:201-707-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00454500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional