Scott D Wallace

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

116999 Issued in MA

Practice address

63 Glenwood St
Lowell, MA 01852-3007

Phone

(978) 804-4068

NPI assigned

Feb 2, 2012

Sex

Male

Sole proprietor

No

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)

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.

• HKD Treatment Options PC

  • Addiction Medicine (Internal Medicine) Physician
  • Lowell, MA
  • NPI 1033476338

  Clinical

  NPD (past)
• LGH Professional Services LLC

  • Internal Medicine Physician
  • Lowell, MA
  • NPI 1417485541
  NPD (past)
• Zuri Counseling Services LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • North Andover, MA
  • NPI 1194266825
  NPD (past)

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339977600000",
    "number": "1184996399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 GLENWOOD ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018523007",
            "telephone_number": "978-804-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 GLENWOOD ST",
            "city": "LOWELL",
            "state": "MA",
            "postal_code": "018523007",
            "telephone_number": "978-804-4068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SCOTT",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-02",
        "last_updated": "2012-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "116999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Eastern Co Inc
• Diana Jean Walker-Moyer, FNP
• Erin B Walker, M.ED
• Racheal Sinmisola Walker, BSN, RN
• Shaylene Wallace-Borden, MA
• Alexandra Wallenstein
• Dan Wallin
• Melanie Walsh-Mager
• Haley Walsh
• Ruth Walsworth, CNP

• Clinical Social Worker in Lowell, MA
• Providers in Lowell, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.