Active NPI
Kathryn Wallace, LCSW
- Clinical Social Worker
- Brighton, MA
National Provider Identifier
1366366007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW2143539
- Practice address
- 495 Western Ave
Brighton, MA 02135-1007 - Phone
- (617) 870-7423
- NPI assigned
- Aug 6, 2026
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW2143539 | MA | Primary |
Addresses
Primary practice location
495 Western Ave
Brighton, MA 02135-1007
Mailing address
270 Norfolk St Apt 6
Cambridge, MA 02139-1447
Other practice location 1
43 Foundry Ave Ste 110
Waltham, MA 02453-8313
Phone (617) 870-7423
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1785974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785974400000",
"number": "1366366007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "270 NORFOLK ST APT 6",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021391447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 WESTERN AVE",
"city": "BRIGHTON",
"state": "MA",
"postal_code": "021351007",
"telephone_number": "617-870-7423"
}
],
"practiceLocations": [
{
"address_1": "43 Foundry Ave Ste 110",
"address_purpose": "LOCATION",
"city": "Waltham",
"state": "MA",
"postal_code": "024538313",
"country_code": "US",
"telephone_number": "617-870-7423",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "KATHRYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-08-06",
"last_updated": "2026-08-06",
"certification_date": "2026-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LCSW2143539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brighton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.