MRS. SUSAN D. WALLACE


Address: 166 Pawtucket Avenue, Pawtucket, RI 02860-3811
Phone: 4017224644

MRS. SUSAN D. WALLACE (NPI# 1447375662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1447375662
Entity Type Individual
Full Name MRS. SUSAN D. WALLACE
Credential MA, LCDCS
Practice Address 166 Pawtucket Avenue
Pawtucket
RI 02860-3811
Practice Telephone 4017224644
Practice Fax Number 4017224867
Mailing Telephone 4017224644
Mailing Fax Number 4017224867
Enumeration Date 2007-03-20
Last Update Date 2007-07-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 101YA0400X Counselor
Specialization: Addiction (Substance Use Disorder)
LCDCS00022 RI Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
RI UNITED HEALTH 62-43157 01

Other Providers SUSAN WALLACE

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1366646457 Susan Taylor Wallace Speech-Language Pathologist 3409 Connection Dr, Fayetteville, NC 28311-0151 2007-06-12
1952426025 Susan Wallace Acupuncturist 1009 Solano Ave, # A, Albany, CA 94706-1617 2007-03-20
1639554769 Susan Wallace Physical Therapist 35 Medical Center Pkwy, Augusta, ME 04330-8160 2015-07-30
1740537687 Susan R Wallace Nurse Practitioner 100 Methodist Blvd, Hattiesburg, MS 39402-1295 2012-08-09
1710247812 Susan Victoria Wallace Marriage & Family Therapist 9685 Hayes St, Riverside, CA 92503-3660 2012-05-22
1427203462 Susan Marie Wallace Occupational Therapist 355 Oak Grove Rd, Spartanburg, SC 29301-2537 2008-11-18
1194985887 Susan Jean Wallace Registered Nurse E Hwy 18, Pine Ridge, SD 57770-1201 2008-06-16

Office Location

Street Address 166 PAWTUCKET AVENUE
City PAWTUCKET
State RI
Zip Code 02860-3811

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1972096923 Lmb Medical LLC Internal Medicine 127 School St, Pawtucket, RI 02860 2018-06-13
1215420435 Tyla Jackson Behavior Technician 70 Wood St Apt 22, Pawtucket, RI 02860 2018-06-12
1376048637 Michael A Iadevaia Family Medicine 111 Brewster St Fl 3, Pawtucket, RI 02860 2018-03-28
1730690488 Anthony Edwin Ramicone Physician Assistant 407 East Ave Ste 120, Pawtucket, RI 02860 2017-10-21
1669991352 Kathleen K. Kroessler, Md; Neurology & Acupuncture, Inc. PC Clinic/Center 407 East Ave; Suite 110, Pawtucket, RI 02860 2017-09-13
1841716230 Ri Alternative Academy Management, LLC Local Education Agency (LEA) 249 Roosevelt Avenue, Pawtucket, RI 02860 2017-08-17
1396265724 Hannah R Stoops Family Medicine 111 Brewster St Fcc A, Pawtucket, RI 02860 2017-06-27
1427578400 Shaun Michael Flynn Family Medicine 111 Brewster St, Fcc A, Pawtucket, RI 02860 2017-06-21
1073051843 Laura Jane Amaral Counselor 750 East Ave Unit 1e, Pawtucket, RI 02860 2017-02-01
1063862027 Stephanie Shoppell Counselor 105 Bacon Street, Pawtucket, RI 02860 2016-06-20
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Taxonomy Information

Taxonomy Code 101YA0400X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Addiction (Substance Use Disorder)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1831741156 Lauren D'andrea Counselor 50 Tobie Ave, Pawtucket, RI 02861-2912 2019-07-16
1073051843 Laura Jane Amaral Counselor 750 East Ave Unit 1e, Pawtucket, RI 02860 2017-02-01
1760929012 Taylor Alexis Daddario Counselor 57 Charlton Ave, Pawtucket, RI 02860-6233 2017-01-25
1164887444 Lori-ann Tetreault Counselor 15 Woodhaven Rd, Pawtucket, RI 02861-3530 2015-12-30
1285018077 David Lussier Counselor 80 Summit St, Pawtucket, RI 02860-4206 2015-07-13
1053533182 Janet Hindley Counselor 115 Hanover Ave, Pawtucket, RI 02861-2129 2007-05-02
1447475074 Robin N. Pierce-pacheco Counselor 31 North Union Street, Pawtucket, RI 02860 2007-04-17
1649300765 Geovany Orrego Counselor 101 Bacon St # 103, Pawtucket, RI 02860-5542 2007-03-07
1194828749 Meredith M Denno Counselor 166 Pawtucket Ave, Pawtucket, RI 02860 2006-09-07
1184237570 Denise Marie Howard Counselor 82 Pond St, Pawtucket, RI 02860-4462 2020-08-26
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Competitor

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City PAWTUCKET
Zip Code 02860

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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