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Individual

MISS CYNTHIA L WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
THERAPIST

Contact information

Practice address
358 SAINT MARKS PL, STATEN ISLAND, NY 10301-2417
(718) 727-3303
Mailing address
51 TREMONT TER, IRVINGTON, NJ 07111-3709

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
171M00000X
Case Manager/Care Coordinator
Primary

Other

Enumeration date
11/16/2011
Last updated
11/16/2011
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