Provider Demographics
NPI:1669756102
Name:WALLACE, ANABELA ALMEIDA (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:ANABELA
Middle Name:ALMEIDA
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 FARNSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1322
Mailing Address - Country:US
Mailing Address - Phone:413-737-4718
Mailing Address - Fax:413-827-7817
Practice Address - Street 1:425 UNION ST
Practice Address - Street 2:LEVEL D
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4115
Practice Address - Country:US
Practice Address - Phone:413-737-4718
Practice Address - Fax:413-827-7817
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2117561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical