Mary Wallis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

086618

Practice address

100 Washington St
Elmira, NY 14901-2849

Phone

(607) 737-4745

Fax

(607) 737-4813

NPI assigned

Nov 5, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1447689971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 LIBERTY ST",
            "city": "BATH",
            "state": "NY",
            "postal_code": "148101508",
            "telephone_number": "607-664-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 WASHINGTON ST",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149012849",
            "telephone_number": "607-737-4745",
            "fax_number": "607-737-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "MARY",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-05",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": "086618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreens
• Christine A. Walker, CNM
• Barbara Jean Wallace, LPN
• Julia B Wallace, LCSWR
• Sharon Wallace, RN
• Kendra Rochelle Walsh, MS, OTR/L
• Kacie Leigh Walton, LMSW
• Kirsten Walton
• Derik Wandell
• Rebecca Wandell

• Clinical Social Worker in Elmira, NY
• Providers in Elmira, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2018; 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.