Jennifer M. Wallace Canobbio, MSW, ASW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

ASW33242 Issued in CA

Practice address

627 Cabrillo Ave
Santa Cruz, CA 95065-1107

Phone

(408) 821-6832

NPI assigned

Jan 9, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer M Wallace Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1357689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357689600000",
    "number": "1396082434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 CABRILLO AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651107",
            "telephone_number": "408-821-6832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 CABRILLO AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950651107",
            "telephone_number": "408-821-6832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANOBBIO",
        "first_name": "JENNIFER",
        "middle_name": "M. WALLACE",
        "credential": "MSW, ASW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-09",
        "last_updated": "2013-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW33242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WALLACE",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diego Alecksander Canales
• Melissa Janelle Canelo
• Milani Canepa
• Anthony Elijah Albert Cano
• Rain Ysabel Cano
• Akila Canton
• Melody Renee Cantrell, FNP-BC, PMHNP-BC
• Genesis Alondra Cantu
• Mylinh Cao
• William Cao, MD

• Clinical Social Worker in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.