Individual
CARLY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
233 MAIN ST, NEW BRITAIN, CT 06051-4204
(860) 977-2324
Mailing address
21 BIDWELL SQ, UNIONVILLE, CT 06085-1115
(860) 977-2324
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11655
CT
1041C0700X
Clinical Social Worker
120747
MA
Other
Enumeration date
01/07/2016
Last updated
02/28/2023
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