Individual
NATALIE MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW,MSW,BA
Contact information
Practice address
72 WEST ST, DANBURY CLINICAL SERVICES, DANBURY, CT 06810-6531
(203) 797-9778
(203) 797-9858
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
061366
NY
104100000X
Social Worker
Primary
3302
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060669107
HEALTHYCT WELLMORE FACILITY/GRP
CT
01
—
13818169
CAQH
CT
01
—
D339229 DANBURY
BEACON HEALTH STRATEGIES
CT
01
—
NOT ELIGIBLE
MHN MANAGED HEALTH NETWORK
CT
01
—
PENDING
AETNA BEHAVIORAL HEALTH
CT
05
—
PENDING
—
CT
Enumeration date
04/12/2016
Last updated
08/29/2016
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