Kelley Wallace, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

113056 Issued in MA

Practice address

399 Lincoln Rd
Walpole, MA 02081-1218

Phone

(508) 668-7703

NPI assigned

Jan 2, 2007

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

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.

• The Home for Little Wanderers

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Walpole, MA
  • NPI 1144488990
  NPD (past)
• The Home for Little Wanders, Longview Farm

  • Mental Illness Community Based Residential Treatment Facility
  • Walpole, MA
  • NPI 1588710156
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750448833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "73 KNIGHT AVE",
            "city": "ATTLEBORO",
            "state": "MA",
            "postal_code": "027037219",
            "telephone_number": "508-455-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 LINCOLN RD",
            "city": "WALPOLE",
            "state": "MA",
            "postal_code": "020811218",
            "telephone_number": "508-668-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KELLEY",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "113056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veterinary Neurology and Pain Management Center of NE
• Myriam T Villalobos, M.ED., M.A.
• Christopher Vona
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walpole Area Visiting Nurse Association, Inc
• Walpole Area Visiting Nurse Association, Inc.
• Walpole Behavioral Healthcare
• Walpole Behavioral Healthcare, LLC
• Walpole Chiropractic Office, Inc.

• Clinical Social Worker in Walpole, MA
• Providers in Walpole, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.