| Name | WALLACH EDWARD S |
|---|---|
| Address | STATEN ISLANDNY |
| Profession | LICENSED CLINICAL SOCIAL WORK |
| License No | 027293 |
| Date of Licensure | 09/01/04 (OriginallylicensedasaCertifiedSocialWorkeron12/31/81) |
| Additional Qualification | R -Psychotherapy Privilege |
| Status | REGISTERED |
| Registered through last day of |