Susan Lee Wallace, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15024 Issued in CA

Practice address

1510 Capitola Rd
Santa Cruz, CA 95062-2912

Phone

(831) 427-3500

NPI assigned

May 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: susan.wallace@schealth.eclinicaldirectplus.com

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.

• Santa Cruz Community Health Centers

  dba East Cliff Family Health Center

  • Clinic/Center
  • Santa Cruz, CA
  • NPI 1952749541
  Medicare reassignment
• El Dorado Center Partial Hospitalization

  • Psychiatric Hospital Unit
  • Santa Cruz, CA
  • NPI 1023228574
  NPD (past)
• Santa Cruz Community Health Centers

  dba Santa Cruz Women's Health Center

  • Family Medicine Physician
  • Santa Cruz, CA
  • NPI 1902923329

  Clinical

  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1972719938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "947 EL DORADO AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622863",
            "telephone_number": "831-479-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 CAPITOLA RD",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950622912",
            "telephone_number": "831-427-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "947 El Dorado Ave",
            "address_purpose": "LOCATION",
            "city": "Santa Cruz",
            "state": "CA",
            "postal_code": "950622863",
            "country_code": "US",
            "telephone_number": "831-479-7195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SUSAN",
        "middle_name": "LEE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "15024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Walker
• David M Wall, MPA, PA-C
• Jack Browning Wallace, PHARM. D
• Jefferey Wallace
• Kieran Wallace
• Deborah Waller, OT
• Marissa Catherine Walls
• Babette Wallters, RN
• Walnut Avenue Family & Women's Center
• Alexis Joy Walsh

• Clinical Social Worker in Santa Cruz, CA
• Providers in Santa Cruz, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.