| Doctor Name: | DR. KENNETH S. WALTERS |
| NPI Number: | 1134162365 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH,D. |
| License Number: | PS1102 |
| Business Practice Address: | 15 Farone Dr Apt B11 Oneonta, NY - 138201337 |
| Business Phone Number: | 6072677480 |
| Business Fax Number: | |
| Mailing Address: | 15 Farone Dr, Apt B-11 ONEONTA |
| State: | NY |
| Postal Code: | 138201316 |
| Phone Number: | 6072677480 |
| Fax Number: | |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 07/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS1102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |