Active NPI
Azaia Wallace
- Clinical Social Worker
- Wesley Chapel, FL
National Provider Identifier
1982287876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 10883-C
- Practice address
- 8039 Lennox Loop
Wesley Chapel, FL 33544-3503 - Phone
- (918) 859-5775
- NPI assigned
- Apr 29, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | |||
| Clinical Social Worker | 1041C0700X | |||
| Clinical Social Worker | 1041C0700X | 10883-C | NV | Primary |
Addresses
Primary practice location
8039 Lennox Loop
Wesley Chapel, FL 33544-3503
Mailing address
8039 Lennox Loop
Wesley Chapel, FL 33544-3503
Phone (918) 859-5775
Other practice location 1
6767 W Tropicana Ave Ste 100
Las Vegas, NV 89103-4755
Phone (702) 209-0370
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV, FL, VA, GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 4
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
8630 W Nevso Dr
Las Vegas, NV 89147-0407
Phone (702) 942-8700
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10883-C | NV | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Harmony Mental Health and Wellness LLC | Clinical | Current | Accepting new patients |
| BMSC NV LLC | Clinical | Current | Accepting new patients |
| Blue Moon Senior Counseling | Clinical | Current | Accepting new patients |
| Thornwell | Social Worker | Past | Accepting new patients |
Locations
2057 Edgewater Dr
Clearwater, FL 33755
Phone (727) 205-7077
15520 NW 2nd Ave
North Miami Beach, FL 33169
Phone (305) 949-2626
10204 Bode St
Ste B
Plainfield, IL 60585
Phone (630) 229-6462
Organizations & group practices 5
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.
-
- Clinical Social Worker
- Las Vegas, NV
- NPI 1245648419
-
- Clinical Social Worker
- St Petersburg, FL
- NPI 1134901838
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725408000000",
"number": "1982287876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8039 LENNOX LOOP",
"city": "WESLEY CHAPEL",
"state": "FL",
"postal_code": "335443503",
"telephone_number": "918-859-5775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8039 LENNOX LOOP",
"city": "WESLEY CHAPEL",
"state": "FL",
"postal_code": "335443503",
"telephone_number": "918-859-5775"
}
],
"practiceLocations": [
{
"address_1": "6767 W Tropicana Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Las Vegas",
"state": "NV",
"postal_code": "891034755",
"country_code": "US",
"telephone_number": "702-209-0370",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "AZAIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-29",
"last_updated": "2024-09-04",
"certification_date": "2024-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NV",
"license": "10883-C",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wesley Chapel, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.