Bruce Wallace

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-5142 Issued in HI

Practice address

85-888 Farrington Hwy
Waianae, HI 96792-2403

Phone

(808) 696-9498

NPI assigned

Aug 26, 2021

Sex

Male

Sole proprietor

Yes

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Waianae Coast Community Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Waianae, HI
  • NPI 1043362338
  NPD (past)

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

{
    "created_epoch": "1629936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1689341679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-226 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-696-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85-888 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967922403",
            "telephone_number": "808-696-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRUCE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-26",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "LCSW-5142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Waianae District Comprehensive Health and Hospital Board, Incorporated
• Waianae Valley Physical Therapy, Inc.
• Cayce Keliikai Waipa, RDH
• Christina Walker, APRN
• Elizabeth Anne Walker, MS, RD
• Kimberly Sue Washington
• Mei Wah Akamu Watson, PSYD
• Amber Weber
• Maria Wells
• Kylene Wenner, CCC-SLP

• Clinical Social Worker in Waianae, HI
• Providers in Waianae, HI by specialty
• Clinical Social Worker in Hawaii

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

Verify at the official NPI Registry.