Individual
DORIAN JAMES WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT-BC
Contact information
Practice address
1510 CARROLL ST APT 2A, BROOKLYN, NY 11213-4527
(330) 592-5264
Mailing address
1510 CARROLL ST APT 2A, BROOKLYN, NY 11213-4527
(330) 592-5264
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
16406
NY
Other
Enumeration date
08/03/2024
Last updated
08/03/2024
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