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CAROLYN WALLACE LICSW NPI 1962595835


NPI Information

NPI: 1962595835
Provider Name: CAROLYN WALLACE, LICSW
Classification: Social Worker - 1041C0700X
Entity Type: Individual

Specialization: Clinical

PECOS Registration: Yes

Address:
66 N MAIN ST
S DEERFIELD, MA
ZIP 01373
Phone: (413) 320-6950
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Carolyn Wallace, LICSW is a clinical social worker in S Deerfield, MA with 30 years of experience. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. Carolyn Wallace, LICSW NPI is 1962595835. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1994

The provider's business location address is:

66 N MAIN ST
S DEERFIELD, MA
ZIP 01373-137
Phone: (413) 320-6950

The NPI 1962595835 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 10/2/2006 and was last updated on 12/20/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11041C0700XSocial WorkerClinical119611MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
111011717BMEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.