NPIMap

Organization Active NPI

Christina M Wallace PSYD

  • Psychologist
  • Beaver, PA
National Provider Identifier
1770069197
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
CHRISTINA M WALLACE PSYD
Practice address
300 S Walnut LN
Beaver, PA 15009-1739
Phone
(412) 974-8550
NPI assigned
Jul 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

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

Authorized official

Name
Christina Wallace, PSYD
Title
Owner
Phone
(412) 974-8550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

300 S Walnut LN
Beaver, PA 15009-1739

Mailing address

301 Macnab Dr
Moon Township, PA 15108-9608
Phone (412) 974-8550

National Provider Directory

National Provider Directory

Locations

300 S Walnut Ln
Ste 201
Beaver, PA 15009
Phone (412) 974-8550

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1531872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1770069197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 MACNAB DR",
            "city": "MOON TOWNSHIP",
            "state": "PA",
            "postal_code": "151089608",
            "telephone_number": "412-974-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S WALNUT LN",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150091739",
            "telephone_number": "412-974-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTINA M WALLACE PSYD",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-18",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "412-974-8550",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 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.