Melissa M. Wallace, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1165 Issued in NH

Practice address

250 Commercial Street
Suite 3004
Manchester, NH 03101-1118

Phone

(603) 668-3050

Fax

(603) 668-8666

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Green House Group PAGroup PAC ID 1153370549, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Green House Group PA

  • Psychologist
  • Manchester, NH
  • NPI 1326256611
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407888000000",
    "number": "1235216482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 COMMERCIAL STREET",
            "address_2": "SUITE 3004",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011118",
            "telephone_number": "603-668-3050",
            "fax_number": "603-668-8666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 COMMERCIAL STREET",
            "address_2": "SUITE 3004",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031011118",
            "telephone_number": "603-668-3050",
            "fax_number": "603-668-8666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MELISSA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NH",
            "license": "1165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3080928",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Pamela Wall, BCBA
• Anita L Wallace, PHARM.D., CGP
• Kaidy Wallace, RDN
• Katelyn Wallace
• Kimberly Pauline Wallace, RPH
• Faith Walmsley
• Robert Walrath
• Carol Struckmeyer Walsh, MS, LGC
• Lyelle A Walsh, MA, LHMC
• Melissa Walsh, CCC-SLP

• Psychologist in Manchester, NH
• Providers in Manchester, NH by specialty
• Psychologist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.