Provider Demographics
NPI:1578583126
Name:ALLEN, BEVERLY L (MSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PATRIOTS SQ
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1517
Mailing Address - Country:US
Mailing Address - Phone:860-456-1770
Mailing Address - Fax:860-779-2122
Practice Address - Street 1:645A N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2108
Practice Address - Country:US
Practice Address - Phone:860-779-2122
Practice Address - Fax:860-779-2123
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1043604OtherCIGNA 03
CT079437OtherMHN
CT11230415OtherMULTIPLAN 03
CTP2806130OtherOXFORD
CT244533OtherMAGELLAN, CLINICAL SOCIAL
CT134345OtherVALUE OPTIONS 03
CTOOO7666432OtherAETNA