Provider Demographics
NPI:1043649122
Name:ALLEN, AMY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1843
Mailing Address - Country:US
Mailing Address - Phone:603-401-4912
Mailing Address - Fax:
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-890-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical