Jill Natalie Wallace, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

15 Heath LN
East Northport, NY 11731-1912

Phone

(516) 459-0312

NPI assigned

Nov 3, 2006

Last updated

Jul 19, 2024By the provider in NPPES

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jill N Wallace LCSW PLLC

  • Social Worker
  • East Northport, NY
  • NPI 1356760037
  Medicare reassignment Authorized official
• Metropolitan Psychological & Licensed Master Social Work Services PLLC

  • Clinical Psychologist
  • Bay Shore, NY
  • NPI 1891833588
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1902985724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 HEATH LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311912",
            "telephone_number": "516-459-0312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HEATH LN",
            "city": "EAST NORTHPORT",
            "state": "NY",
            "postal_code": "117311912",
            "telephone_number": "516-459-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JILL",
        "middle_name": "NATALIE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01742630",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Raymond Wagner, M.D.
• Elizabeth Wakhale
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #02630)
• Kimberly Michele Walker, DPT
• Samantha Kate Walsh, L.AC
• Daniel Warrick, LMT
• Warwick Green M.B.B.S., P.C
• Christine Watson, OTRL
• Kieran Weaver, PA-C

• Social Worker in East Northport, NY
• Providers in East Northport, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.