Provider Demographics
NPI:1508302217
Name:WALLEN, VICTOR (MSW PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:WALLEN
Suffix:
Gender:M
Credentials:MSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4406
Mailing Address - Country:US
Mailing Address - Phone:954-471-8591
Mailing Address - Fax:954-796-4155
Practice Address - Street 1:9000 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4406
Practice Address - Country:US
Practice Address - Phone:954-471-8591
Practice Address - Fax:954-796-4155
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker