MARY D WALLACE (NPI# 1619045648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619045648 |
| Entity Type | Individual |
| Full Name | MARY D WALLACE |
| Credential | L.C.S.W.R. |
| Practice Address |
105 Broadview Dr Syracuse NY 13215-1505 |
| Practice Telephone | 3154751297 |
| Mailing Telephone | 3154751297 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
R014836-1 | NY | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528585031 | Mary Wallace | Psychologist | 1605 E Ash St, Canton, IL 61520-1510 | 2017-08-25 |
| 1801136809 | Mary Etheridge Wallace | Counselor | 303 E. Main Street Suite 9, Elizabeth City, NC 27909 | 2013-02-27 |
| 1851541163 | Mary Caroline Wallace | Speech-Language Pathologist | 5 5th St Se, Washington, DC 20003-1119 | 2008-09-23 |
| 1245446723 | Mary Frances Wallace | Massage Therapist | 3301 River Ave, Huntington, WV 25705-2807 | 2007-05-14 |
| 1134253396 | Mary Beth Wallace | Speech-Language Pathologist | 2461 Highway 1, Harrisburg, AR 72432-9479 | 2007-03-16 |
| 1013451608 | Mary Elise Wallace | Dietitian, Registered | 3600 Gaston Ave, Suite 656, Dallas, TX 75246-1800 | 2016-12-15 |
| 1982156766 | Mary Terese Wallace | Dietitian, Registered | 700 Broadway, Seattle, WA 98122-4302 | 2016-10-27 |
| 1194173443 | Mary Wallace | Case Manager/Care Coordinator | 627 S Elliott Ave, Wenatchee, WA 98801-3195 | 2016-05-27 |
| 1255760898 | Mary Wallace | Counselor | 1818 Se Division St, Portland, OR 97202-1159 | 2013-11-04 |
| 1811127947 | Mary Virginia Wallace | Social Worker | 1401 N Central Expy, Suite 375, Richardson, TX 75080-4669 | 2009-07-23 |
| Street Address |
105 BROADVIEW DR |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13215-1505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396367785 | Jeffrey Alan Gaulrapp | Registered Nurse | Upstate University Hospital Community General Campus, 4900 Broad Road, Syracuse, NY 13215 | 2020-05-08 |
| 1134752454 | Crystal Elizabeth Hoban | Marriage & Family Therapist | 4922 W. Seneca Turnpike, Syracuse, NY 13215 | 2020-02-14 |
| 1083004907 | Roger G Levine Md | Psychiatric Residential Treatment Facility | 4914 West Seneca Turnpkie, Syracuse, NY 13215 | 2015-01-30 |
| 1558771071 | Edleanna Robinson | Licensed Practical Nurse | 5075 W Seneca Turnpike, Syracuse, NY 13215 | 2014-05-06 |
| 1689013450 | Rhonda Lee Philopena | Emergency Medicine | 4900 Broad Rd 1st Fl, Syracuse, NY 13215 | 2013-06-14 |
| 1962778498 | Marie Anne Stevens | Licensed Practical Nurse | 4057 Seneca Tpk, Van Duyn Home and Hospital, Syracuse, NY 13215 | 2012-03-29 |
| 1033439088 | Anna-marie Simpson | Chiropractor | 4922 W Seneca Tpke, Syracuse, NY 13215 | 2010-06-01 |
| 1992028690 | A John Wylie | Pharmacist | 4840 Sherwood Dr., Syracuse, NY 13215 | 2010-03-09 |
| 1669616512 | Asalim A Thabet | Emergency Medicine | 4900 Braod Rd, 1st Fl, Syracuse, NY 13215 | 2009-04-22 |
| 1992948707 | Jesse Reed Gutnick | Surgery | 4900 Borad Rd, Suite 23 North, Syracuse, NY 13215 | 2009-04-08 |
| Find all providers in zip 13215 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558973586 | Maizie Marie Shaw | Social Worker | 660 Madison Street, Syracuse, NY 13210 | 2020-08-20 |
| 1063023265 | Jessica Kaye Bouges | Social Worker | 821 E Brighton Ave Apt 802, Syracuse, NY 13205-2508 | 2020-08-11 |
| 1164044087 | Ednita Marie Wright | Social Worker | 135 Alanson Rd, Syracuse, NY 13207-1503 | 2020-05-13 |
| 1801416383 | Sara Danielle Mcalister | Social Worker | 5133 Kasson Rd, Syracuse, NY 13215-8623 | 2020-04-24 |
| 1598392110 | Jean M Burdick | Social Worker | 6900 Thompson Rd, Syracuse, NY 13211-1328 | 2020-03-24 |
| 1013491737 | Patrick Alvin Ryan | Social Worker | 602 Crossett St, Syracuse, NY 13207-1250 | 2018-09-18 |
| 1881182020 | Diandra Morse | Social Worker | 3532 James St Ste 112, Syracuse, NY 13206-2547 | 2018-04-24 |
| 1083122311 | Amber Oliver | Social Worker | 307 Cambridge Ave, Syracuse, NY 13208-1446 | 2018-01-22 |
| 1700394152 | Celia Kamps, Lcsw, Pllc | Social Worker | 2507 James St Ste 206, Syracuse, NY 13206-2825 | 2018-01-19 |
| 1699283770 | Karla Beth Murphy | Social Worker | 635 Madison Street, Syracuse, NY 13210 | 2018-01-11 |
| Find all providers in SYRACUSE | ||||
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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.