Provider Demographics
NPI:1780355800
Name:WALLACE, RACQUEL ELIZABETH (MFT)
Entity type:Individual
Prefix:MRS
First Name:RACQUEL
Middle Name:ELIZABETH
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3322
Mailing Address - Country:US
Mailing Address - Phone:347-360-3704
Mailing Address - Fax:
Practice Address - Street 1:1990 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2902
Practice Address - Country:US
Practice Address - Phone:609-359-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist