Provider Demographics
NPI:1336110790
Name:NUTTBROCK-ALLEN, DEANNA LEANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LEANNE
Last Name:NUTTBROCK-ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MACPHERSON ROBERTSON WAY
Mailing Address - Street 2:
Mailing Address - City:MILDENHALL
Mailing Address - State:SUFFOLK
Mailing Address - Zip Code:IP28 7RS
Mailing Address - Country:GB
Mailing Address - Phone:0778-974-6927
Mailing Address - Fax:
Practice Address - Street 1:48 MDG
Practice Address - Street 2:UNIT 5210 BOX 230
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461
Practice Address - Country:GB
Practice Address - Phone:0163-854-3308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002982103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent