Provider Demographics
NPI:1326454141
Name:BOUTWELL, ALLISON MCLEOD (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MCLEOD
Last Name:BOUTWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:JANE
Other - Last Name:MCLEOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6310
Mailing Address - Country:US
Mailing Address - Phone:813-290-8560
Mailing Address - Fax:813-435-2033
Practice Address - Street 1:4902 EISENHOWER BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6310
Practice Address - Country:US
Practice Address - Phone:813-290-8560
Practice Address - Fax:813-435-2033
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical