Active NPI
Gregory Wallace, LCSWC
- Clinical Social Worker
- Rockville, MD
National Provider Identifier
1700898012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12531
- Practice address
- 932 Hungerford Dr Ste 18B
Rockville, MD 20850-1751 - Phone
- (301) 806-1892
- Fax
- (301) 468-1862
- NPI assigned
- Aug 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 12531 | MD | |
| Clinical Social Worker | 1041C0700X | 12531 | MD | Primary |
Addresses
Primary practice location
932 Hungerford Dr Ste 18B
Rockville, MD 20850-1751
Mailing address
6005 Camelback LN
Columbia, MD 21045-3810
Phone (301) 806-1892
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 248050 | Other | MD | KAISER |
| 406695200 | Medicaid | MD | |
| 64403601 | Other | MD | BCBS OF MD |
| 7383677 | Other | MD | AETNA |
| 724490000 | Other | MD | MAGELLAN |
| A2840144 | Other | DC | BCBS OF DC |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12531 | MD | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677715200000",
"number": "1700898012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6005 CAMELBACK LN",
"city": "COLUMBIA",
"state": "MD",
"postal_code": "210453810",
"telephone_number": "301-806-1892",
"fax_number": "301-468-1862"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "932 HUNGERFORD DR STE 18B",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208501751",
"telephone_number": "301-806-1892",
"fax_number": "301-468-1862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "GREGORY",
"name_prefix": "Mr.",
"credential": "LCSWC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-13",
"last_updated": "2023-03-02",
"certification_date": "2023-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MD",
"license": "12531",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MD",
"license": "12531",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER",
"identifier": "248050",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "406695200",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MD",
"identifier": "64403601",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7383677",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "724490000",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF DC",
"identifier": "A2840144",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.