Provider Demographics
NPI:1205995412
Name:HANDY, WALLACE (LCSW)
Entity type:Individual
Prefix:
First Name:WALLACE
Middle Name:
Last Name:HANDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E STEIN HWY
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1416
Mailing Address - Country:US
Mailing Address - Phone:302-875-2487
Mailing Address - Fax:
Practice Address - Street 1:306 E STEIN HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1416
Practice Address - Country:US
Practice Address - Phone:302-875-2487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ10000560101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE491979Medicare ID - Type UnspecifiedMEDICARE