Provider Demographics
NPI:1154868362
Name:BROUGHTON, ALLISON MARY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARY
Last Name:BROUGHTON
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 1:36 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2973
Mailing Address - Country:US
Mailing Address - Phone:781-942-9277
Mailing Address - Fax:781-944-6535
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 207-L
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:781-942-9277
Practice Address - Fax:781-944-6535
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical