Healthcare Provider Details

I. General information

NPI: 1346617347
Provider Name (Legal Business Name): ZEHAVA TAMAR WALLACE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W FLAGLER ST STE 900
MIAMI FL
33130-1807
US

IV. Provider business mailing address

286 GRAYSON PL
TEANECK NJ
07666-3406
US

V. Phone/Fax

Practice location:
  • Phone: 786-244-7711
  • Fax:
Mailing address:
  • Phone: 347-322-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103204
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: