Basic Information
Provider Information
NPI: 1689336687
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: DARREN
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8620 18TH AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112143702
CountryCode: US
TelephoneNumber: 7182342144
FaxNumber:  
Practice Location
Address1: 8620 18TH AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112143702
CountryCode: US
TelephoneNumber: 7182342144
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/07/2021
LastUpdateDate: 10/07/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/07/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X NYY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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