| Doctor Name: | MR. MICHAEL PATRICK WALL |
| NPI Number: | 1063552586 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSWC |
| License Number: | LCSWC07449 |
| Business Practice Address: | 692 Ritchie Hwy Suite 203 Severna Park, MD - 211463919 |
| Business Phone Number: | 4106474862 |
| Business Fax Number: | |
| Mailing Address: | 64 Dungarrie Rd, BALTO |
| State: | MD |
| Postal Code: | 212283401 |
| Phone Number: | 4103822859 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCSWC07449 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |