Wallace, Susan D.
Wallace, Susan D. is an individual health care provider with primary practice located at 166 Pawtucket Avenue , Pawtucket RI 02860-3811. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Wallace, Susan D. can be contacted via phone (401) 722-4644.Contact Information
Primary practice address
166 Pawtucket Avenue
Pawtucket RI 02860-3811
Phone: (401) 722-4644
Fax: (401) 722-4867
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | LCDCS00022 | Rhode Island |
Profile Details
| NPI number | 1447375662 |
|---|---|
| LBN Legal business name | Wallace, Susan D. |
| Credentials | MA, LCDCS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 20th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447375662 | NPPES |
| Rhode Island | Other | 62-43157 | UNITED HEALTH |
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