Provider Demographics
NPI:1861645970
Name:WALLACE, NANCY E (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:WALLACE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 78TH ST
Mailing Address - Street 2:STE. 27
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2022
Mailing Address - Country:US
Mailing Address - Phone:917-842-4733
Mailing Address - Fax:
Practice Address - Street 1:230 E 78TH ST
Practice Address - Street 2:STE. 27
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2022
Practice Address - Country:US
Practice Address - Phone:917-842-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029274-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical