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General NPI Number Information
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NPI Number | 1194817445
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Entity Type | Individual
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Provider Name | SARENE MALCHA WALLICK LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 DOUGLAS AVE STE 2005
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3315
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Country | US
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Telephone | 407-529-5359
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Fax |
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Provider Business Mailing Address
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Address Line | 1056 GORE DR
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City | OVIEDO
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State | FL
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Zip | 32765-7058
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Country | US
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Telephone | 407-927-9718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW7232
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License Number State | FL
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