Active NPI
Mary Wallace
- Psychiatric/Mental Health Registered Nurse
- Half Moon Bay, CA
National Provider Identifier
1639297021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- License
- 219605
- Practice address
- 225 Cabrillo Hwy S
Suite 200a
Half Moon Bay, CA 94019-8200 - Phone
- (650) 573-3724
- Fax
- (650) 726-4963
- NPI assigned
- Mar 26, 2007
- Last updated
- Sep 11, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC31243 | CA | |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 219605 | CA | Primary |
Addresses
Primary practice location
225 Cabrillo Hwy S
Suite 200a
Half Moon Bay, CA 94019-8200
Mailing address
225 Cabrillo Hwy S
Suite 200a
Half Moon Bay, CA 94019-8200
Phone (650) 573-3724
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC31243 | CA | MD | Marriage & Family Therapist |
| 219605 | CA | MD | Psychiatric/Mental Health Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of San Mateo | Past | Accepting new patients | |
| Central County Mental Health Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Nursing Care Agency
- San Mateo, CA
- NPI 1710165048
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1639297021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 CABRILLO HWY S",
"address_2": "SUITE 200A",
"city": "HALF MOON BAY",
"state": "CA",
"postal_code": "940198200",
"telephone_number": "650-573-3724",
"fax_number": "650-726-4963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "225 CABRILLO HWY S",
"address_2": "SUITE 200A",
"city": "HALF MOON BAY",
"state": "CA",
"postal_code": "940198200",
"telephone_number": "650-573-3724",
"fax_number": "650-726-4963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC31243",
"primary": false
},
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "CA",
"license": "219605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Half Moon Bay, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.