DR. RANDALL KENT WALLACE (NPI# 1891049003) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891049003 |
| Entity Type | Individual |
| Full Name | DR. RANDALL KENT WALLACE |
| Credential | PSY.D. |
| Practice Address |
36 Russ St Hartford CT 06106-1520 |
| Practice Telephone | 8604669411 |
| Mailing Telephone | 8604669411 |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2016-11-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
2544 | CT | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497820252 | Randall Allen Wallace | Physical Therapist | 409 E. California Ave., Oaklahoma City, OK 73104 | 2006-11-21 |
| 1689768707 | Randall Dean Wallace | Psychologist | 133 2nd Ave Sw, Cambridge, MN 55008-1552 | 2006-10-03 |
| Street Address |
36 RUSS ST |
| City | HARTFORD |
| State | CT |
| Zip Code | 06106-1520 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750907325 | Vartika Kesarwani | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-19 |
| 1720602865 | Meher Kaur Singha | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-04 |
| 1497314140 | Eduardo Mantovani Cardoso | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-06-06 |
| 1114582178 | Dimitrios Drekolias | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-05-06 |
| 1316501687 | Rafae Shaikh | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-04-23 |
| 1437643715 | Lucas Bensa | Social Worker | 421 Washington St., Apt C1, Hartford, CT 06106 | 2018-06-19 |
| 1548754310 | Collin Dimler | Physician Assistant | 85 Seymour St Ste 1003, Hartford, CT 06106 | 2018-06-15 |
| 1619460581 | Bryan F Stringer | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 | 2018-06-14 |
| 1083103972 | Margret Sigurdardottir Blondal | Student in an Organized Health Care Education/Training Program | 282 Washington Street, Ste 4h, Hartford, CT 06106 | 2018-05-07 |
| 1265920995 | Rudra Ramanathan | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave Brown Stone, Hartford, CT 06106 | 2018-04-27 |
| Find all providers in zip 06106 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366065963 | Leah Elizabeth Morgan | Psychologist | 56 Arbor St Ste 100-a, Hartford, CT 06106-1222 | 2020-05-19 |
| 1306318670 | Integrative Psychological Center LLC | Psychologist | 44 Capitol Ave Ste 402, Hartford, CT 06106-1764 | 2018-12-26 |
| 1326553983 | Marissa Sicley-rogers | Psychologist | 200 Retreat Ave Bldg 5th, Hartford, CT 06106-3309 | 2017-12-05 |
| 1508394834 | Ct Psychological Consulting Services, LLC | Psychologist | 210 Wethersfield Ave Fl 2, Hartford, CT 06114-1113 | 2017-05-31 |
| 1326399213 | Kathryne Stuart Marinchak | Psychologist | 135 Allen Pl, Hartford, CT 06106-3103 | 2012-10-02 |
| 1255681813 | Silvia Corbera Lopez | Psychologist | 200 Retreat Avnue, Hartford Hospital Psychiatry Dept, Hartford, CT 06106-3310 | 2012-09-11 |
| 1801165469 | Angelica Valentin-colon | Psychologist | 151 New Park Avenue, Suite 117, Hartford, CT 06106-2152 | 2011-12-27 |
| 1184776163 | Stephen Michael Humphrey | Psychologist | 602 New Britain Ave, Hartford, CT 06106-4033 | 2007-01-18 |
| 1275609711 | Sean Timothy Hart | Psychologist | 864 Wethersfield Avenue First Floor, Hartford Center for Psychotherapy, Hartford, CT 06114 | 2006-11-27 |
| 1588733190 | Sarah F. Pearlman | Psychologist | 791 Prospect Ave, Hartford, CT 06105-4233 | 2006-11-07 |
| Find all providers in HARTFORD | ||||
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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.