Provider Demographics
NPI:1326234840
Name:ALLOWAY, DERRICK JASON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:JASON
Last Name:ALLOWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2748
Mailing Address - Country:US
Mailing Address - Phone:201-207-9243
Mailing Address - Fax:888-627-5578
Practice Address - Street 1:305 PARK AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2748
Practice Address - Country:US
Practice Address - Phone:201-207-9243
Practice Address - Fax:888-627-5578
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058247-11041C0700X
44SC053916001041C0700X
NJ1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0397458Medicaid