Provider Demographics
NPI:1588224521
Name:VAN ALLEN, KERRIANN DIANA (MED, MS)
Entity Type:Individual
Prefix:MRS
First Name:KERRIANN
Middle Name:DIANA
Last Name:VAN ALLEN
Suffix:
Gender:F
Credentials:MED, MS
Other - Prefix:MS
Other - First Name:KERRIANN
Other - Middle Name:DIANA
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:367 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1930
Mailing Address - Country:US
Mailing Address - Phone:413-737-1426
Mailing Address - Fax:
Practice Address - Street 1:367 PINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1930
Practice Address - Country:US
Practice Address - Phone:413-737-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor