Provider Demographics
NPI:1598804544
Name:ALLEN, JOHN KEVIN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:WEST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02574-0849
Mailing Address - Country:US
Mailing Address - Phone:508-353-2353
Mailing Address - Fax:
Practice Address - Street 1:50 FAIRWAY LN
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2036
Practice Address - Country:US
Practice Address - Phone:508-353-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-06-06
Deactivation Date:2013-02-27
Deactivation Code:
Reactivation Date:2018-06-06
Provider Licenses
StateLicense IDTaxonomies
MA2584103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist