Provider Demographics
NPI:1366655789
Name:ALLEN, JUDITH LYNN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:LYNN
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1631 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4809
Mailing Address - Country:US
Mailing Address - Phone:407-644-5437
Mailing Address - Fax:407-270-2433
Practice Address - Street 1:1631 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4809
Practice Address - Country:US
Practice Address - Phone:407-644-5437
Practice Address - Fax:407-270-2433
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11845436OtherCAQH
FL7283700Medicaid
FLSW7092OtherDOH LICENSE #
FL768827000Medicaid