Individual
DR. JOHN HUGH G WALLACE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
NAVAL AMBULATORY CARE CENTER, ROUTE 12, BLDG 449, ATTN: PROFESSIONAL AFFAIRS, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Mailing address
NAVAL AMBULATORY CARE CENTER, ROUTE 12, BLDG 449, ATTN: PROFESSIONAL AFFAIRS, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810002367
VA
Other
Enumeration date
11/15/2005
Last updated
07/08/2007
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