DR. TIMOTHY R WALLACE (NPI# 1437149739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437149739 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY R WALLACE |
| Credential | PHD |
| Practice Address |
125 Nashua Street Spaulding Rehab Hospital Boston MA 02114-1198 |
| Mailing Address |
Po Box 9142 Mass General Physician Organization Charlestown MA 02129-9142 |
| Practice Telephone | 6175732694 |
| Practice Fax Number | 2175732229 |
| Mailing Telephone | 6177240287 |
| Mailing Fax Number | 6177262894 |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 4282 | MA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 0395471 | 05 | |
| MA | BCBS MA | W50958 | 01 |
| MA | TUFTS | 456014 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063438307 | Timothy Mark Wallace | Chiropractor | 4357 Phelan Rd, Phelan, CA 92371-7675 | 2006-07-13 |
| 1619527611 | Timothy Wallace | Case Manager/Care Coordinator | 774 Internet Dr, Columbus, OH 43207-2589 | 2019-09-12 |
| 1396987657 | Timothy Brian Wallace II | Anesthesiology | 550 Peachtree St Ne, Atlanta, GA 30308-2212 | 2009-04-01 |
| 1003072414 | Timothy Thomas Wallace Jr. | Registered Nurse | 10000 Brecksville Rd, Brecksville, OH 44141-3204 | 2008-08-05 |
| 1275725384 | Timothy R Wallace | Family Medicine | 855 N Westhaven Dr, Oshkosh, WI 54904-7668 | 2007-08-13 |
| 1033328703 | Timothy J Wallace | Radiology | 401 College St, Richmond, VA 23298-5017 | 2007-05-21 |
| 1720013121 | Timothy M Wallace | Pathology | 36500 Aurora Dr, Summit, WI 53066-4899 | 2006-07-12 |
| 1841215902 | Timothy Brian Wallace | Anesthesiology | 6605 Abercorn St, Suite 108, Savannah, GA 31405-5815 | 2006-07-12 |
| 1700850674 | Timothy Wallace | Physician Assistant | 450 Clarkson Ave, Box 56, Brooklyn, NY 11203-2056 | 2006-02-15 |
| Street Address |
125 NASHUA STREET SPAULDING REHAB HOSPITAL |
| City | BOSTON |
| State | MA |
| Zip Code | 02114-1198 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790794832 | Juan L Asanza | Physical Medicine & Rehabilitation | 125 Nashua Street, Physical Medicine and Rehabilitation, Boston, MA 02114 | 2006-08-07 |
| 1609856087 | Edward Michael Phillips | Physical Medicine & Rehabilitation | 125 Nashua Street, Spaulding Rehabilitation Hospital, Boston, MA 02114 | 2006-01-20 |
| 1427048735 | Nimet Ender Oruc | Physical Medicine & Rehabilitation | 125 Nashua Street, Srh, Boston, MA 02114-1198 | 2005-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588276281 | Guoliang Qiao | Student in an Organized Health Care Education/Training Program | Massachusetts General Hospital, 55 Fruit Street., Boston, MA 02114 | 2020-08-24 |
| 1881223741 | Alexander Wesley Zirulnik | Student in an Organized Health Care Education/Training Program | 55 Fruit St. Boston, Boston, MA 02114 | 2020-04-03 |
| 1376170548 | Mia Yu Bothwell | Student in an Organized Health Care Education/Training Program | Gray Bigelow 730, 55 Fruit Street, Boston, MA 02114 | 2020-03-26 |
| 1225661036 | David Dongkyung Kim | Student in an Organized Health Care Education/Training Program | 6 Whittier Place, Apartment 15b, Boston, MA 02114 | 2020-02-20 |
| 1124651658 | Madeleine Sertic | Student in an Organized Health Care Education/Training Program | Division of Abdominal Imaging, Department of Radiology, 55 Fruit Street, White 270, Boston, MA 02114 | 2020-02-12 |
| 1285274498 | Jiuk James Jung | Student in an Organized Health Care Education/Training Program | 15 Parkman Ave, Wang 4-460, Boston, MA 02114 | 2020-01-15 |
| 1831740448 | Jennifer Hughes | Physician Assistant | 55 Fruit Street, Founders 110, Boston, MA 02114 | 2019-09-25 |
| 1558827220 | Aluma Chovel Sella | Student in an Organized Health Care Education/Training Program | Massgeneral Hospital for Children Main Campus, 55 Fruit Street, Boston, MA 02114 | 2019-02-18 |
| 1083187140 | Henry Oliveras | Massage Therapist | 102 Charles Street, Boston, MA 02114 | 2019-01-10 |
| 1720550031 | Nicole M Price | Social Worker | 29 Staniford St, Boston, MA 02114 | 2018-12-27 |
| Find all providers in zip 02114 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841897345 | Sade Callwood | Psychologist | 185 Devonshire St Ste 800, Boston, MA 02110-1414 | 2020-10-07 |
| 1184239808 | Morgan Eleanor Smigielski | Psychologist | 65 Park Dr Apt 18, Boston, MA 02215-5238 | 2020-09-10 |
| 1679183230 | Holly Muller | Psychologist | 225 Friend St, Boston, MA 02114-1800 | 2020-08-07 |
| 1942826813 | David Leo Pendergast | Psychologist | 36 A St Unit 6c, Boston, MA 02127-1870 | 2020-06-17 |
| 1063035566 | Hermine Muskat | Psychologist | 1313 Washington St Apt 521, Boston, MA 02118-2170 | 2020-05-19 |
| 1750914503 | Stephanie Petit Jean Louis | Psychologist | 80 Fenwood Rd Unit 405, Boston, MA 02115-6138 | 2020-02-20 |
| 1164078754 | Alexandria Miller | Psychologist | 801 Massachusetts Ave # 2067, Boston, MA 02118-2605 | 2019-08-10 |
| 1356824288 | Mira Mooreville Nurko | Psychologist | 71 Rockview St, Boston, MA 02130-2147 | 2018-09-06 |
| 1083195416 | Lawrence Pilkington Stifler | Psychologist | 99 Summer St Fl 12, Boston, MA 02110-1213 | 2018-08-23 |
| 1952896326 | Amy R. Pettit | Psychologist | 11 Deerfield St, Boston, MA 02215-5600 | 2018-06-27 |
| Find all providers in BOSTON | ||||
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| 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.