Debra Wallace, LMSW
Individual provider Active NPI Social Worker · Greece, NY
NPI 1386517050 · NPPES record last updated Sep 27, 2025
Key facts
- NPI
- 1386517050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 127173-01 (NY)
- Practice address
- 1100 Long Pond Rd
Greece, NY 14626-1177 - Phone
- (585) 385-6030
- NPI assigned
- Sep 27, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 127173-01 | NY | MD | Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 127173-01 | NY | Yes |
Addresses
Primary practice location
1100 Long Pond Rd
Greece, NY 14626-1177
Mailing address
PO Box 411
North Chili, NY 14514-0411
Phone (585) 261-9059
Other providers in Greece, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.