Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jaime Wallace, PHD

Individual provider Psychologist · NPI 1366783557

Dr. Jaime Wallace, PHD is a Clinical Psychologist in Garden City, New York. Qualified in 2012, 14 years ago. Practices as a sole proprietor. Licensed in New York.

Years since qualifying
14
Licensed in
NY
In the registry since
2013
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

198 Fernwood Ter
Garden City, NY 11530-5010
Phone: (516) 457-4992
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 8017984 (NY)
Psychologist Taxonomy 103T00000X · Licence 8017984 (NY)

Record details

NPI number1366783557
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorYes
NPI enumeratedMarch 13, 2013
Last updated in NPPESMarch 13, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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