Provider Demographics
NPI:1518424506
Name:ALLEN, BEVERLY SUSAN (MA, LADC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:SUSAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3810
Mailing Address - Country:US
Mailing Address - Phone:802-917-2431
Mailing Address - Fax:802-622-0956
Practice Address - Street 1:2 NORTH ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3810
Practice Address - Country:US
Practice Address - Phone:802-917-2431
Practice Address - Fax:802-622-0956
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0128112101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)