Provider Demographics
NPI:1295845089
Name:ALLISON, STEVEN MARC (PSYD LICSW)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARC
Last Name:ALLISON
Suffix:
Gender:M
Credentials:PSYD LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DERBY ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-741-9991
Mailing Address - Fax:781-449-3657
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-741-9991
Practice Address - Fax:781-449-3657
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891146Medicaid
R43763Medicare UPIN
MA1891146Medicaid