Provider Demographics
NPI:1598797649
Name:ALLEN, TERRI D (MSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:D
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 1:6535 N CHARLES STREET
Mailing Address - Street 2:STE 300
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-938-5252
Mailing Address - Fax:410-938-6250
Practice Address - Street 1:6535 N CHARLES STREET
Practice Address - Street 2:STE 300
Practice Address - City:BALTO
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-938-5252
Practice Address - Fax:410-938-6250
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD067641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R13087Medicare UPIN
MDHM88Medicare ID - Type Unspecified