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1891049003
RANDALL KENT WALLACE
HARTFORD, CT
NPI
1891049003
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: CT 2544)
Enumeration Date
2012-11-09
Last Update Date
2016-11-09
Business Address
Dr. RANDALL KENT WALLACE Psy.D.
36 RUSS ST
HARTFORD, CT 06106-1520
Phone number: 860-466-9411
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Mailing Address
Dr. RANDALL KENT WALLACE Psy.D.
36 RUSS ST
HARTFORD, CT 06106-1520
Phone number: 860-466-9411
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