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Individual

MRS. CAROLINE MADELINE WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, BCBA

Contact information

Practice address
4 BROADWAY AVE EXT, UNIT 3, STONINGTON, CT 06378
(860) 980-3233
Mailing address
5 WOOD CREST DR, OLD LYME, CT 06371-2840
(207) 228-3291

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
805
CT

Other

Enumeration date
05/22/2019
Last updated
05/22/2019
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