Wallace, Robert Lee

Wallace, Robert Lee is an individual health care provider with primary practice located at 100 Willow St , Lynn MA 01901-1139. He recently has only one registered license in Other Service Providers / Case Manager/Care Coordinator, which is considered as his primary health care specialty. Wallace, Robert Lee can be contacted via phone (781) 691-7060.

Contact Information

Primary practice address
100 Willow St Lynn MA 01901-1139
Phone: (781) 691-7060
Fax: (781) 691-7064
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Case Manager/Care Coordinator 171M00000X Massachusetts

Profile Details

NPI number 1538706957
LBN Legal business name Wallace, Robert Lee
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 4th, 2019
Last updated Dec 4th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538706957 NPPES
Massachusetts MEDICAID 171M00000X

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