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1073207049
KEVIN WALLACE
TEANECK, NJ
NPI
1073207049
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
104100000X Social Worker
(Licence: NY 095669)
Enumeration Date
2023-06-05
Last Update Date
2023-06-05
Business Address
KEVIN WALLACE LMSW
799 JOHN ST
TEANECK, NJ 07666-5333
Phone number: 917-327-7162
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Mailing Address
KEVIN WALLACE LMSW
799 JOHN ST
TEANECK, NJ 07666-5333
Phone number:
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