Individual
LYLE G WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
36 WALKER RD, WEST ORANGE, NJ 07052-4403
(973) 715-5591
Mailing address
36 WALKER RD, WEST ORANGE, NJ 07052-4403
(973) 715-5591
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
44SL04765500
NJ
Other
Enumeration date
05/29/2022
Last updated
05/29/2022
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