Kathleen M. Wallace, PSY.D
Individual provider Active NPI Clinical Psychologist · Vienna,, OH
NPI 1770636367 · NPPES record last updated Sep 15, 2025
Key facts
- NPI
- 1770636367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PS015630 (PA)
- Practice address
- 3400 Warren-Sharon Road
Vienna,, OH 44473-9532 - Phone
- (330) 720-5786
- NPI assigned
- Jan 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1992
- Medicare assignment
- May accept Medicare assignment
- Group practices
- People in Need-Lawrence County
Practice addresses (Care Compare)
2703 W State St
New Castle, PA 16101-8645
Phone 7246573303101
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130919000671 | PA | Practitioner - Clinical Psychologist | 2163666892 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4820 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| People in Need - Lawrence County | Clinical | Current |
Accepting new patients |
| People in Need-Lawrence County | Current | Accepting new patients | |
| People in Need - Lawrence County | Current |
Accepting new patients | |
| Steward Medical Group Inc. | Current | Accepting new patients | |
| Steward Medical Group, Inc | Current |
Accepting new patients | |
| Steward Medical Group Inc. | Current |
Accepting new patients |
Locations
500 Gypsy Ln
Youngstown, OH 44504
Phone (330) 740-4572
2320 Highland Rd
Hermitage, PA 16148
Phone (724) 983-5900
2375 Garden Way
Hermitage, PA 16148
Phone (724) 983-5454
2703 W State St
New Castle, PA 16101
Phone 7246573303 ext. 101
2395 Garden Way
Sharon, PA 16148
Phone (724) 342-5890
740 E State St
Sharon, PA 16146
Phone (724) 983-1980
951 Male Rd
Wind Gap, PA 18091
Phone (610) 654-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS015630 | PA | Yes |
| Clinical Psychologist | 103TC0700X | 4820 | OH |
Addresses
Primary practice location
3400 Warren-Sharon Road
Vienna,, OH 44473-9532
Mailing address
3438 Warren Sharon Rd
Vienna, OH 44473-9532
Phone (330) 720-5786
Other practice location 1
2703 W State St
New Castle, PA 16101-8645
Phone (724) 657-3303 ext. 101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7412444 | Other | AETNA | |
| 000000867501 | Other | ANTHEM BLUE CROSS BLUE SHIELD | |
| 0213754 | Medicaid | OH | |
| 102574943 | Medicaid | PA | |
| 175402 | Other | MHNET | |
| 001947342 | Other | PA | HIGHMARK BLUE SHIELD |
| 1044444 | Other | CIGNA | |
| 251830792 | Other | MULTIPLAN PHCS |
Other providers in Vienna,, OH
- Vienna Dental Center, Bart L. James, DDS, Roger L. Clouse, DDS, LTD.
- Vienna Medical Arts Clinic, Inc
- Vienna Pharmacy Care LLC
- Vienna Township Ttee
- Vanessa Vince - Deniro
- Kenneth Ralph Wallace II
All providers in Vienna,, OH · Clinical Psychologist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.