Provider Demographics
NPI:1356464507
Name:ALLIS, ROBIN
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:ALLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 137
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9730
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-265-6741
Practice Address - Street 1:RR 1 BOX 137
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9730
Practice Address - Country:US
Practice Address - Phone:570-265-0100
Practice Address - Fax:570-265-6741
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124284104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker