Active NPI
Joseph Patrick Wallace Jr., PHD
- Clinical Psychologist
- Danbury, CT
National Provider Identifier
1790839728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 000905
- Practice address
- 44 North Street
Danbury, CT 06810 - Phone
- (203) 743-4065
- Fax
- (914) 248-1615
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 000905 | CT | Primary |
Addresses
Primary practice location
44 North Street
Danbury, CT 06810
Mailing address
44 North Street
Danbury, CT 06810
Phone (203) 743-4065
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000905 | CT | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790839728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 NORTH STREET",
"city": "DANBURY",
"state": "CT",
"postal_code": "06810",
"telephone_number": "203-743-4065",
"fax_number": "914-248-1615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44 NORTH STREET",
"city": "DANBURY",
"state": "CT",
"postal_code": "06810",
"telephone_number": "203-743-4065",
"fax_number": "914-248-1615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JOSEPH",
"middle_name": "PATRICK",
"name_suffix": "Jr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "000905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Danbury, CT
Sources for this page
- 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.