Individual
AMY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
34 SEALS DR, MONROE, NY 10950-3949
(845) 248-3057
Mailing address
34 SEALS DR, MONROE, NY 10950-3949
(845) 248-3057
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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