IndividualActive
Reginal Wallace, LCSW
NPI 1205400066 · Clinical Social Worker · Winter Haven, FL
Provider details
- NPI number
- 1205400066
- Entity type
- Individual
- Primary specialty
- Clinical Social WorkerBehavioral Health & Social Service Providers
- Credential
- LCSW
- Sex
- Male
- Sole proprietor
- No
- License
- SW18482 (FL)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1201 1st St S
Winter Haven, FL 33880-3904
Phone: (863) 293-1121
Street-level locationGet directions
Mailing address
2995 Drew St Fl 3
Clearwater, FL 33759-3012
Registry dates
- Enumerated
- 2021-05-17
- Last updated
- 2021-10-04
- Certified
- 2021-10-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.