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Jessica Wallace, LMSW
NPI 1649751801 · on the registry since 2018 · sole proprietor
Practice
- Address
- 75 Grand Ave
Massapequa, NY 11758 - Phone
- (516) 799-3203
- Organisation at this address
- Youth Environmental Services, Inc.
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 55
Registry record
- Primary taxonomy
- 104100000X
104100000X
- Licence states on file
- NY
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-04-14
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in New York