Provider Demographics
NPI:1225587736
Name:WALLACE, CAROLINE (MSW, LCSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 UNION ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-4100
Mailing Address - Country:US
Mailing Address - Phone:413-206-9172
Mailing Address - Fax:
Practice Address - Street 1:123 UNION ST STE 201
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-4100
Practice Address - Country:US
Practice Address - Phone:413-206-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1226441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical