Jonathan Marc Wallis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS19858 Issued in CA

Practice address

1610 Scott St
San Francisco, CA 94115-3014

Phone

(415) 820-9609

NPI assigned

May 18, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mr. J. Marc Wallis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242604800000",
    "number": "1124253307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 SCOTT ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153014",
            "telephone_number": "415-820-9609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 SCOTT ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153014",
            "telephone_number": "415-820-9609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JONATHAN",
        "middle_name": "MARC",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-18",
        "last_updated": "2009-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "102L00000X",
            "taxonomy_group": "",
            "desc": "Psychoanalyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS19858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "J.",
            "last_name": "WALLIS",
            "middle_name": "MARC",
            "prefix": "MR.",
            "credential": "LCSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Margaret Ingrid Wallhagen, RN, GNP, PHD
• Dina Wallin, MD
• Wendy Anne Wallin, PA
• Kendahl Wallis-Lang
• Christopher James Wallis, M.D.
• Benjamin Nicholas Walls, RN
• Jessica Leigh Walls, M.D.
• Tierra Shardai Walls
• Carol Beebe Walser, PH.D.
• Brian J Walsh, PAC

• Clinical Social Worker in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.