Organization
ASCENDING PSYCHOTHERAPY-PW LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA WALLACE LCSW-R (OWNER)
(917) 224-5793
Entity
Organization
Contact information
Practice address
14722 VILLAGE RD APT 82B, JAMAICA, NY 11435-6307
(917) 224-5793
Mailing address
14722 VILLAGE RD APT 82B, JAMAICA, NY 11435-6307
(917) 224-5793
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
075520
NY
Other
Enumeration date
12/05/2017
Last updated
03/17/2018
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