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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
RI | UNITED HEALTH | 62-43157 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477910792 | Susan Anne Wallace | Licensed Practical Nurse | 44 Beechwood Dr, Manorville, NY 11949-2947 | 2016-01-16 |
1376842732 | Susan Elizabeth Wallace | Dietitian, Registered | 102 Carran Dr, Lakeside Park, KY 41017-2233 | 2011-03-23 |
1598904427 | Susan Leigh Wallace | Specialist | 103 Windwood Rd, North Syracuse, NY 13212-1956 | 2009-02-17 |
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 |
Street Address |
166 PAWTUCKET AVENUE |
City | PAWTUCKET |
State | RI |
Zip Code | 02860-3811 |
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 |
Find all providers in zip 02860 |
Taxonomy Code | 101YA0400X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Counselor |
Specialization | Addiction (Substance Use Disorder) |
Definition to come... |
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 |
Find all providers in PAWTUCKET |
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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.