Individual
DR. JOHN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
275 NORTH ST, HARRISON, NY 10528-1524
(914) 337-6033
Mailing address
275 NORTH ST, HARRISON, NY 10528-1524
(914) 337-6033
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
005179-1
NY
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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