Provider Demographics
NPI:1114005063
Name:ALLEN, KENNETH R (MSW, LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 RITCHIE HWY STE G
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6940
Mailing Address - Country:US
Mailing Address - Phone:410-544-4927
Mailing Address - Fax:410-544-4928
Practice Address - Street 1:8131 RITCHIE HWY STE G
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6940
Practice Address - Country:US
Practice Address - Phone:410-544-4927
Practice Address - Fax:410-544-4928
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD068731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD503P984GOtherMEDICARE PTAN
MD503P984GOtherMEDICARE PTAN