Laney Elizabeth Wallace, MPS, LCAT, ATR-BC

Primary specialty

Art TherapistTaxonomy code 221700000X

License

002041 Issued in NY

Practice address

515 Madison Ave FL 21
New York, NY 10022-5433

Phone

(515) 577-6281

NPI assigned

Nov 5, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alchemy Creative Arts Therapy LLC

  • Mental Health Counselor
  • New York, NY
  • NPI 1386498277
  NPD Authorized official

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1124662929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 COLES ST APT 506",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073101046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 MADISON AVE FL 21",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100225433",
            "telephone_number": "515-577-6281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LANEY",
        "middle_name": "ELIZABETH",
        "credential": "MPS, LCAT, ATR-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-05",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": "NY",
            "license": "002041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Jerome Wallace, CASAC-T
• David Wallace
• Kathleen Wallace
• Kisha Wallace
• Kyana Wallace, PA-C
• Lauren Wallace
• Loretta Wallace
• Mario James Wallace, PT, DPT
• Marisa I Wallace, DNP, FNP-BC
• Mark Edward Wallace, M.D.

• Art Therapist in New York, NY
• Providers in New York, NY by specialty
• Art Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.