Individual
DR. JENNIFER WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
594 BROADWAY RM 907, NEW YORK, NY 10012-3289
(617) 571-6811
Mailing address
594 BROADWAY, NEW YORK, NY 10012-3233
(617) 571-6811
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
022264
NY
Other
Enumeration date
08/04/2017
Last updated
08/04/2017
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