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NICOLE M. WALLACE MSW, LCSW
NPI 1275821993
Social Worker - Clinical in Huntington, NY

Active since July 15, 2011Opted out of Medicare · through Sep 11, 2027
177 MAIN ST STE 206, HUNTINGTON, NY 11743(631) 380-3454 Get Directions Write a Review

NPPES record last updated: March 17, 2018. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Mar 17, 2018, Jul 13, 2017 (2 updates tracked since 2017).

About Nicole M. Wallace Msw, Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE M. WALLACE MSW, LCSW (NPI 1275821993) is an individual clinical provider in Huntington, New York, licensed in New York (084663) and active in the NPI registry since July 2011. She has opted out of Medicare through September 11, 2027 and maintains a secondary practice location in Brooklyn.

NPPES Registry Identity

NPI1275821993
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameNICOLE M. WALLACECredential: MSW, LCSW
Location Address177 MAIN ST STE 206Huntington, NY 11743-6917
Mailing Address177 Main St Ste 206Huntington, NY 11743-6917
Phone(631) 380-3454
Sole ProprietorNo
Enumeration DateJuly 15, 2011
Last NPPES UpdateMarch 17, 20182 updates tracked since enumeration
✔ NPI 1275821993 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in NY · 084663
Definition
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.
Also ListedSocial WorkerTaxonomy 104100000X · License 084063 (NY)
177 MAIN ST STE 206, Huntington, NY 11743
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Secondary Practice Location 1

Location 1180 Livingston St, Suite 303Brooklyn, NY 11201-5861 · Phone (347) 328-8110

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Nicole M. Wallace Msw, Lcsw has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from September 11, 2023 through September 11, 2027.

Opt-Out Effective DateSeptember 11, 2023
Opt-Out In Effect ThroughSeptember 11, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINDFUL JOURNEY: MENTAL HEALTH COUNSELING, PLLC
Clinic/Center (Mental Health (Including Community Mental Health Center))
177 MAIN ST STE 206
HUNTINGTON, NY 11743
Suffolk County (516) 360-0945
DR. ANNE ROBERTSON PSYD
Psychologist (Clinical)
177 MAIN ST STE 206
HUNTINGTON, NY 11743
Suffolk County (631) 683-8995

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicole Wallace's NPI number?

The NPI number for Nicole Wallace is 1275821993. It was assigned to this individual provider in the NPPES registry on July 15, 2011.

Where is Nicole Wallace located?

Nicole Wallace practices at 177 Main St Ste 206, Huntington, NY 11743. The listed phone number is (631) 380-3454.

What is Nicole Wallace's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Nicole Wallace enrolled in Medicare?

No. Nicole Wallace has opted out of Medicare through September 11, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Nicole Wallace was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.