Individual
STACEY WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
116 W BROAD ST, BURLINGTON CITY, NJ 08016-1410
(609) 386-0650
(609) 386-0652
Mailing address
116 W BROAD ST, BURLINGTON CITY, NJ 08016-1410
(609) 386-0650
(609) 386-0652
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL05147700
NJ
Other
Enumeration date
09/25/2014
Last updated
09/25/2014
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