Beth Wallach, Ma, Psychologist, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

BETH WALLACH, MA, PSYCHOLOGIST, LLC

Practice address

1061 Waterdam Plaza Dr Ste 208
Canonsburg, PA 15317-5408

Phone

(724) 413-4991

Fax

(724) 260-0221

NPI assigned

Mar 1, 2007

Last updated

Feb 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Elizabeth Wallach, MANPI 1750409041

Title

Psychologist

Phone

(724) 413-4991

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 2

• Beth or Elizabeth Daily Wallach MA Former legal business name
• Elizabeth Wallach, MA, Psychologist Former legal business name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Elizabeth Wallach Ma Psychologist2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Elizabeth Wallach Ma Psychologist

  • Psychologist
  • McMurray, PA
  • NPI 1588836936
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Wallach, MA

  • Psychologist
  • Canonsburg, PA
  • NPI 1750409041
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1285762336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 WATERDAM PLAZA DR STE 208",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153175408",
            "telephone_number": "724-413-4991",
            "fax_number": "724-260-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 WATERDAM PLAZA DR STE 208",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153175408",
            "telephone_number": "724-413-4991",
            "fax_number": "724-260-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH WALLACH, MA, PSYCHOLOGIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "status": "A",
        "authorized_official_last_name": "WALLACH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "724-413-4991",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS6340L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001523992001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beth or Elizabeth Daily Wallach MA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Elizabeth Wallach, MA, Psychologist",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Blooming Brains Therapy LLC

• Adult Mental Health Clinic/Center in Canonsburg, PA
• Providers in Canonsburg, PA by specialty
• Adult Mental Health Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.