Individual
KEVIN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
799 JOHN ST, TEANECK, NJ 07666-5333
(917) 327-7162
Mailing address
799 JOHN ST, TEANECK, NJ 07666-5333
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
095669
NY
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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