MRS. SUSAN O'BRIEN WALLACE (NPI# 1295907392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295907392 |
| Entity Type | Individual |
| Full Name | MRS. SUSAN O'BRIEN WALLACE |
| Credential | PSY. D. |
| Practice Address |
1454 E 2nd St San Bernardino CA 92408-0118 |
| Mailing Address |
530 S Lake Ave # 565 Pasadena CA 91101-3515 |
| Practice Telephone | 9093827100 |
| Mailing Telephone | 6196657781 |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2018-02-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY27744 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477910792 | Susan Anne Wallace | Licensed Practical Nurse | 44 Beechwood Dr, Manorville, NY 11949-2947 | 2016-01-16 |
| 1376842732 | Susan Elizabeth Wallace | Dietitian, Registered | 102 Carran Dr, Lakeside Park, KY 41017-2233 | 2011-03-23 |
| 1598904427 | Susan Leigh Wallace | Specialist | 103 Windwood Rd, North Syracuse, NY 13212-1956 | 2009-02-17 |
| 1366646457 | Susan Taylor Wallace | Speech-Language Pathologist | 3409 Connection Dr, Fayetteville, NC 28311-0151 | 2007-06-12 |
| 1952426025 | Susan Wallace | Acupuncturist | 1009 Solano Ave, # A, Albany, CA 94706-1617 | 2007-03-20 |
| 1447375662 | Susan D. Wallace | Counselor | 166 Pawtucket Avenue, Pawtucket, RI 02860-3811 | 2007-03-20 |
| 1639554769 | Susan Wallace | Physical Therapist | 35 Medical Center Pkwy, Augusta, ME 04330-8160 | 2015-07-30 |
| 1740537687 | Susan R Wallace | Nurse Practitioner | 100 Methodist Blvd, Hattiesburg, MS 39402-1295 | 2012-08-09 |
| 1710247812 | Susan Victoria Wallace | Marriage & Family Therapist | 9685 Hayes St, Riverside, CA 92503-3660 | 2012-05-22 |
| 1427203462 | Susan Marie Wallace | Occupational Therapist | 355 Oak Grove Rd, Spartanburg, SC 29301-2537 | 2008-11-18 |
| Street Address |
1454 E 2ND ST |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92408-0118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679575682 | Joycelyn Mallari | Pharmacist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2005-08-10 |
| 1679031595 | Genice L Schumann | Nurse Practitioner | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2019-03-10 |
| 1851704605 | Hang Lee | Nurse Practitioner | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2014-06-10 |
| 1407282676 | Maryellen Westerberg | Dietitian, Registered | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2013-09-19 |
| 1194048835 | Daniel Ninan | Dentist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2010-03-09 |
| 1528241916 | Roxana Pomeroy | Dentist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-12-09 |
| 1922298744 | Linda Marie War | Counselor | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-07-27 |
| 1164612982 | Patrick Tobin | Counselor | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-07-27 |
| 1689896821 | Donna Smith-burgess | Marriage & Family Therapist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-05-03 |
| 1245450576 | Rodney Lee Turner | Dentist | 1454 E 2nd St, San Bernardino, CA 92408-0118 | 2007-04-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073124681 | Valeria Armentilla Cecena | Student in an Organized Health Care Education/Training Program | 1950 Sunwest Ln., San Bernardino, CA 92408 | 2020-08-17 |
| 1588272066 | Horizon Therapy Services | Physical Therapist | 418 East Vanderbilt, San Bernardino, CA 92408 | 2020-07-21 |
| 1821627639 | Bl Anderson Medical Corporation | Emergency Medicine | 473 E Carnegie Dr., Ste 200, San Bernardino, CA 92408 | 2020-04-03 |
| 1922648104 | Infinite Hope Hospice Corp | Hospice Care, Community Based | 225 W Hospitality Ln Suite 305, San Bernardino, CA 92408 | 2020-01-15 |
| 1689210775 | Inland Empire Community Outreach Center | Counselor | 473 East Carnegie Drive, Suite 200, San Bernardino, CA 92408 | 2019-11-23 |
| 1992347801 | Care Marriage and Family Therapists, Inc. | Marriage & Family Therapist | 1881 Commercenter Drive E, Suite 232, San Bernardino, CA 92408 | 2019-10-11 |
| 1366084360 | Theraville Counseling Services, A Licensed Clinical Social Worker Corp | Social Worker | 155 W Hospitality Ln Ste 245, San Bernardino, CA 92408 | 2019-10-10 |
| 1548730419 | Adriana Alcaraz | Behavior Technician | 473 E Carnegie, Ste 200, San Bernardino, CA 92408 | 2018-12-04 |
| 1811467889 | Xavier J Molina-williams | Behavior Technician | 476 E Carnegie Drive, Ste 200, San Bernardino, CA 92408 | 2018-12-03 |
| 1780153148 | Gillian Washington | Behavior Technician | 473 E Carnegie Dr, Ste 200, Riverside, CA 92408 | 2018-11-15 |
| Find all providers in zip 92408 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760850770 | Barbaradee Foote | Psychologist | 155 E 54th St, San Bernardino, CA 92404-1116 | 2015-09-08 |
| 1811179682 | Western Pacific Psychological Network, Inc. | Psychologist | 435 Orange Show Ln Ste 105, San Bernardino, CA 92408-2015 | 2007-12-03 |
| 1659430577 | Heidi D Knipe Laird | Psychologist | 1325 Auto Plaza Dr, Suite 110, San Bernardino, CA 92408 | 2006-12-06 |
| 1699856229 | James Bernard Pace | Psychologist | 1255 E Highand Ave, Suite 216, San Bernardino, CA 92404 | 2006-10-18 |
| 1366466518 | Joan Francis | Psychologist | 1911 Commercenter E Ste 101, San Bernardino, CA 92408-3480 | 2006-07-27 |
| 1245259258 | Kohut Psychiatric Medical Group Inc | Psychologist | 1800 Medical Center Drive, Suite 300, San Bernardino, CA 92411 | 2006-07-19 |
| 1073032389 | Krystle Rose Frazier-philo | Psychologist | 686 E Mill St, San Bernardino, CA 92415-0647 | 2017-09-18 |
| 1538695770 | Inland Psychiatric Medical Group, Inc. | Psychologist | 1800 Medical Center Dr, Suite 300, San Bernardino, CA 92411-1218 | 2017-05-09 |
| 1770027633 | Sara Dickes Hernandez | Psychologist | 1638 Windsor St, San Bernardino, CA 92407-3364 | 2016-12-12 |
| 1952858961 | Uchenna Nnaji | Psychologist | 900 E Gilbert St, Cottage 4, San Bernardino, CA 92415-0911 | 2016-09-07 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92408 |
Please comment or provide details below to improve the information on MRS. SUSAN O'BRIEN WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.