Provider Demographics
NPI:1003129776
Name:ALLEN, BECKY (BA, CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BA, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 EAST 138TH STREET
Mailing Address - Street 2:ROOM 32 ALBERT EINSEIN WELLNESS CENTER
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454
Mailing Address - Country:US
Mailing Address - Phone:718-665-7500
Mailing Address - Fax:718-665-4768
Practice Address - Street 1:804 EAST 138TH STREET
Practice Address - Street 2:ROOM 32 ALBERT EINSEIN WELLNESS CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454
Practice Address - Country:US
Practice Address - Phone:718-665-7500
Practice Address - Fax:718-665-4768
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22573101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)