Most Relevant Information
Provider Data
| NPI Number: | 1003238205 |
| Provider Name: | EDWARD S WALLACH LCSW, PH.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | R027293 |
Most Important Dates
| Enumeration Date: | 01/08/2014 |
| Last Updated: | 01/08/2014 |
Provider Practice Location
673 STEWART AVENUE
STATEN ISLAND
NY
10314
Practice Location Phone/Fax
| Phone: | 7186981795 |
| Fax: | 7186989357 |
Provider Mailing Location
673 STEWART AVENUE
STATEN ISLAND
NY
10314
Provider Mailing Phone/Fax
| Phone: | 7186981795 |
| Fax: | 7186989357 |