Jill N Wallace LCSW PLLC

Primary specialty

Social WorkerTaxonomy code 104100000X

License

R045832 Issued in NY

Legal business name

JILL N WALLACE LCSW PLLC

Practice address

15 Heath LN
East Northport, NY 11731-1912

Phone

(516) 459-0312

NPI assigned

Apr 10, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Jill N Wallace, LCSWNPI 1902985724

Title

Owner

Phone

(516) 459-0312

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jill Natalie Wallace, LCSW

  • Social Worker
  • East Northport, NY
  • NPI 1902985724
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1356760037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 HEATH LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311912",
            "telephone_number": "516-459-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HEATH LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311912",
            "telephone_number": "516-459-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JILL N WALLACE LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-10",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-459-0312",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": "NY",
            "license": "R045832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mona Ismail
• J. Richard Lawrence
• John Russell Jacobson, PH.D.
• Jacqueline Raffaele, LCSW, PC
• Joan B Jennings, M.S.,CCC
• John E Lagner DMD PC
• John S. Ferraro, DO, PC
• Alexa Johnson
• Rincy Johnson, PHARMD
• Althea Jola

• Social Worker in East Northport, NY
• Providers in East Northport, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.