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

Tyler Wallace, LMSW-CC

Individual provider Clinical Social Worker · NPI 1043036874

Tyler Wallace, LMSW-CC is a Clinical Social Worker in Portland, Maine. Licensed in Maine. Registered with an NPI since 2024.

Licensed in
ME
In the registry since
2024

Practice location Address checks out

901 Washington Ave Ste 100
Portland, ME 04103-2842
Phone: (207) 871-1200
Fax: (207) 871-1232
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence MC24119 (ME)

Record details

NPI number1043036874
Entity typeIndividual (Type 1)
GenderMale
Credentials LMSW-CC
Sole proprietorNo
NPI enumeratedNovember 26, 2024
Last updated in NPPESNovember 26, 2024
Certification dateNovember 26, 2024
Mailing address901 Washington Ave Ste 100, Portland, ME 04103-2842

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