Provider Demographics
NPI:1376964007
Name:ALLEN, COREY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COREY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 NORTH AVE
Mailing Address - Street 2:APT 238
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-2355
Mailing Address - Country:US
Mailing Address - Phone:203-609-3252
Mailing Address - Fax:
Practice Address - Street 1:21 BRIDGE SQ
Practice Address - Street 2:2ND FLOOR CORNER SUITE
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5900
Practice Address - Country:US
Practice Address - Phone:203-609-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-24
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0084501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical