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

Individual provider Clinical Social Worker · NPI 1982269155

Dylan Wallace, LCSW, QCSW is a Clinical Social Worker in Plymouth, Massachusetts. Qualified in 2013, 13 years ago. Practices with Meadowbrook Counseling of Utah LLC, a 17-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida, Idaho, Massachusetts and Utah and 1 more.

Years since qualifying
13
Licensed in
FL, ID, MA, UT, WA
In the registry since
2019
Specialties on file
5
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

34 Main Street Ext Ste 104
Plymouth, MA 02360-3375
Phone: (801) 655-5450
Fax: (385) 225-9327
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1469 N 1200 W, Orem, UT 84057-2449 — (801) 655-5450

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LICSW126861 (MA)
Clinical Social Worker Taxonomy 1041C0700X · Licence SWI.LW.61224850 (WA)
Clinical Social Worker Taxonomy 1041C0700X · Licence SW15210 (FL)
Clinical Social Worker Taxonomy 1041C0700X · Licence 3381901 (ID)
Clinical Social Worker Taxonomy 1041C0700X · Licence 11338410-3501 (UT)

Record details

NPI number1982269155
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW , QCSW
Sole proprietorNo
NPI enumeratedMay 3, 2019
Last updated in NPPESApril 2, 2026
Certification dateApril 2, 2026

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Meadowbrook Counseling Of Utah Llc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Plymouth