Active NPI
Diana Wallace, LCSW
- Clinical Social Worker
- Newport, KY
National Provider Identifier
1336145432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 3632
- Practice address
- 1 Nunn Dr
University Center, Suite 440
Newport, KY 41099-0002 - Phone
- (859) 572-5650
- Fax
- (859) 572-5615
- NPI assigned
- Jun 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 005144 | CT | |
| Clinical Social Worker | 1041C0700X | 3632 | KY | Primary |
Addresses
Primary practice location
1 Nunn Dr
University Center, Suite 440
Newport, KY 41099-0002
Mailing address
1 Nunn Dr
University Center, Suite 440
Newport, KY 41099-0002
Phone (859) 572-5650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005144 | CT | MD | Clinical Social Worker |
| 3632 | KY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339459200000",
"number": "1336145432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 NUNN DR",
"address_2": "UNIVERSITY CENTER, SUITE 440",
"city": "NEWPORT",
"state": "KY",
"postal_code": "410990002",
"telephone_number": "859-572-5650",
"fax_number": "859-572-5615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 NUNN DR",
"address_2": "UNIVERSITY CENTER, SUITE 440",
"city": "NEWPORT",
"state": "KY",
"postal_code": "410990002",
"telephone_number": "859-572-5650",
"fax_number": "859-572-5615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DIANA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-23",
"last_updated": "2012-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "005144",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "KY",
"license": "3632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newport, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.