Provider Demographics
NPI:1124564364
Name:ALLEN, MEGAN (MSW, RCSWI)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 PETUNIA TER
Mailing Address - Street 2:APT 306
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-6531
Mailing Address - Country:US
Mailing Address - Phone:321-444-2815
Mailing Address - Fax:
Practice Address - Street 1:220 PETUNIA TER
Practice Address - Street 2:APT 306
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-6531
Practice Address - Country:US
Practice Address - Phone:321-444-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty