Provider Demographics
NPI:1568944957
Name:ALLEN, ELAINE SERA (LICSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SERA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2036
Mailing Address - Country:US
Mailing Address - Phone:978-460-4360
Mailing Address - Fax:
Practice Address - Street 1:157 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2036
Practice Address - Country:US
Practice Address - Phone:978-460-4360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical