Individual
MR. BRADLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
175 FEDERAL ST STE 1400, BOSTON, MA 02110-2237
(617) 336-3246
Mailing address
175 FEDERAL ST, ST 1400, BOSTON, MA 02110-2237
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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