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General NPI Number Information
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NPI Number | 1386517050
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Entity Type | Individual
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Provider Name | DEBRA WALLACE LMSW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2025
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Last Update Date | 09/27/2025
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Provider Practice Location Address
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Address Line | 1100 LONG POND RD
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City | GREECE
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State | NY
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Zip | 14626-1177
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Country | US
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Telephone | 585-385-6030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 411
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City | NORTH CHILI
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State | NY
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Zip | 14514-0411
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Country | US
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Telephone | 585-261-9059
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 127173-01
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License Number State | NY
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