Mrs Susan O'brien Wallace, PSY D is a
Psychologist - Clinical based in San Bernardino, California. Mrs Susan O'brien Wallace is licensed to practice in California (license number PSY27744) and her current practice location is
1454 E 2nd St, San Bernardino, California. She can be reached at her office (for appointments etc.) via phone at
(909) 382-7100.
NPI number for Mrs Susan O'brien Wallace is 1295907392 and her current mailing address is 530 S Lake Ave # 565, Pasadena, California. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1295907392.
Healthcare Provider's Profile
| Full Name | Mrs Susan O'brien Wallace |
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| Gender | Female |
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| Speciality | Psychologist - Clinical |
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| Location | 1454 E 2nd St, San Bernardino, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1295907392
- Provider Enumeration Date: 03/28/2008
- Last Update Date: 02/21/2018
Medical Identifiers
Medical identifiers for Mrs Susan O'brien Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1295907392 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | PSY27744 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Susan O'brien Wallace is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mrs Susan O'brien Wallace, PSY D
530 S Lake Ave # 565,
Pasadena, CA 91101-3515
Ph: (619) 665-7781 | Mrs Susan O'brien Wallace, PSY D
1454 E 2nd St,
San Bernardino, CA 92408-0118
Ph: (909) 382-7100 |
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