Keyonna Wallace

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

31387 Issued in NY

Practice address

8002 Kew Gardens Rd Ste 704
Kew Gardens, NY 11415-3607

Phone

(718) 520-1513

NPI assigned

Jan 8, 2020

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Arms Acres, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Jamaica, NY
  • NPI 1265020259
  NPD
• Arms Acres Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Carmel, NY
  • NPI 1235184227
  NPD (past)

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1861032864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 GLENRIDGE RD",
            "city": "GLENVILLE",
            "state": "NY",
            "postal_code": "123024523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8002 KEW GARDENS RD STE 704",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114153607",
            "telephone_number": "718-520-1513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 W 50th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100201201",
            "country_code": "US",
            "telephone_number": "212-582-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KEYONNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "31387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01420795",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Virgilio Lopez Valencia, RN
• Kenneth Veliky, DC
• Raul Luis Vilca, MD
• Vidhi Pramod Vora
• VS Medical Supply Inc
• Dorine Walski, OT/L
• Dikyi Wangmo
• Ayman S Wasef, PT: DPT
• David Washington, LMSW
• Jeffrey M Weinberg, MD

• Addiction (Substance Use Disorder) Counselor in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.