| Dr Seth Willard Wallace, PHD, MS, LPC | |
|
1224 Farmington Ave, Unit D, Kensington, CT 06037-2360 | |
| (860) 817-1331 | |
| Not Available |
| Full Name | Dr Seth Willard Wallace |
|---|---|
| Gender | Male |
| Speciality | Counselor - Professional |
| Location | 1224 Farmington Ave, Kensington, Connecticut |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982894564 | NPI | - | NPPES |
| 001604 | Other | CT | LICENSE NUMBER AS PROFESS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 001604 (Connecticut) | Primary |
| 103TS0200X | Psychologist - School | 070 CERTIFICATION (Connecticut) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Seth Willard Wallace, PHD, MS, LPC Po Box 303, Kensington, CT 06037-0303 Ph: (860) 817-1331 | Dr Seth Willard Wallace, PHD, MS, LPC 1224 Farmington Ave, Unit D, Kensington, CT 06037-2360 Ph: (860) 817-1331 |
Mr. James William Osborne, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1981 Chamberlain Hwy, Kensington, CT 06037 Phone: 860-836-9527 |