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Organization
JILL N WALLACE LCSW PLLC
Active
Organization
JILL N WALLACE LCSW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL N WALLACE LCSW (OWNER)
(516) 459-0312
Entity
Organization
Contact information
Practice address
15 HEATH LN, EAST NORTHPORT, NY 11731-1912
(516) 459-0312
Mailing address
15 HEATH LN, EAST NORTHPORT, NY 11731-1912
(516) 459-0312
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
R045832
NY
Other
Enumeration date
04/10/2014
Last updated
07/19/2024
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