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

MS. Jill Natalie Wallace, LCSW

Individual provider Social Worker · NPI 1902985724

MS. Jill Natalie Wallace, LCSW is a Clinical Social Worker in East Northport, New York. Qualified in 1992, 34 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
34
Licensed in
NY
In the registry since
2006
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

15 Heath Ln
East Northport, NY 11731-1912
Phone: (516) 459-0312
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X (NY)

Record details

NPI number1902985724
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorYes
NPI enumeratedNovember 3, 2006
Last updated in NPPESJuly 19, 2024
Certification dateJuly 19, 2024

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1992 (34 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in East Northport