Melissa Emily Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW17470 Issued in FL

Practice address

1473 Cypress View LN
Lakeland, FL 33811-2689

Phone

(863) 899-7613

NPI assigned

Jan 13, 2016

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

Other names 1

• Melissa Emily Martinez Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Yantra Psychiatric Services, Inc.

  • Psychiatry Physician
  • Lakeland, FL
  • NPI 1528588878
  NPD

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

{
    "created_epoch": "1452643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1841656311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 S FLORIDA AVE STE 33",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338133312",
            "telephone_number": "863-450-3067",
            "fax_number": "863-337-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1473 CYPRESS VIEW LN",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338112689",
            "telephone_number": "863-899-7613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MELISSA",
        "middle_name": "EMILY",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-13",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW17470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MARTINEZ",
            "middle_name": "EMILY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tia Antwonette Walker
• Tierra Shenae Walker, CNA
• Rachel Anne Wall, MD
• Ward B. Wall Jr., M.D.
• Kiblena Wallace, BCBA
• Nicole Wallace, PA
• Shannon Wallace, HOME HEATH AIDE
• Rebecca Waller-Ellison, MA
• Izella Walls
• Rosemary Walls

• Clinical Social Worker in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.

Verify at the official NPI Registry.