Individual
MRS. LACEY MARIE WALLACE-CZIRJAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15 WEST PROSPECT STREET, EAST BRUNSWICK, NJ 08816
(732) 254-0600
(732) 254-8606
Mailing address
4 MASON AVE, EAST BRUNSWICK, NJ 08816
(732) 715-1877
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SC05313200
NJ
Other
Enumeration date
06/08/2010
Last updated
06/15/2010
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