Individual
KEZIA WALLERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 HIGH ST APT C1, MONTCLAIR, NJ 07042-2452
(315) 415-7148
Mailing address
25 HIGH ST APT C1, MONTCLAIR, NJ 07042-2452
(315) 415-7148
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
174400000X
Specialist
—
—
174H00000X
Health Educator
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/12/2026
Last updated
02/12/2026
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