National Provider Identifier
Maxwell Wallace, PSYD
Maxwell Wallace, PSYD is listed in the NPPES registry with a primary specialty of Clinical Psychologist in Rochester, NY and a listed phone number of (585) 449-0125.
Source: public NPPES record, last updated July 19, 2018. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1639676299
- Provider Type
- Individual
- Primary Specialty
- Clinical Psychologist
- Enumeration Date
- April 10, 2018
- Last Updated
- July 19, 2018
Practice Location
- 600 Park Avenue
- Carriage House
- Rochester, NY 14607
Phone: (585) 449-0125
Specialties
- Clinical Psychologist (103TC0700X)
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Full Record
- NPI
- 1639676299
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Maxwell
- Name Prefix
- Dr.
- Credential
- PSYD
- Mailing Street Address
- 600 Park Avenue
- Mailing Address Line 2
- Carriage House
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14607
- Mailing Country
- US
- Mailing Phone
- (585) 449-0125
- Practice Street Address
- 600 Park Avenue
- Practice Address Line 2
- Carriage House
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14607
- Practice Country
- US
- Practice Phone
- (585) 449-0125
- Enumeration Date
- April 10, 2018
- Last Updated
- July 19, 2018
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Clinical Psychologist (103TC0700X)
- Other Identifiers
- 6147215 (NY, Aetna)