Provider Demographics
NPI:1275778292
Name:WALLOWER, JOSEPHINE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:
Last Name:WALLOWER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:WALLOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1983 MARCUS AVE
Mailing Address - Street 2:SUITE E100,
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1016
Mailing Address - Country:US
Mailing Address - Phone:516-326-5641
Mailing Address - Fax:516-326-5676
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE E100,
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1016
Practice Address - Country:US
Practice Address - Phone:516-326-5641
Practice Address - Fax:516-326-5676
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072130-11041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool