Provider Demographics
NPI:1609230051
Name:ALLEN, RICHELLE (PHD)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
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 107
Mailing Address - Street 2:
Mailing Address - City:CONNELLY
Mailing Address - State:NY
Mailing Address - Zip Code:12417-0107
Mailing Address - Country:US
Mailing Address - Phone:617-610-7017
Mailing Address - Fax:
Practice Address - Street 1:113 FIRST STREET
Practice Address - Street 2:
Practice Address - City:CONNELLY
Practice Address - State:NY
Practice Address - Zip Code:12417-1241
Practice Address - Country:US
Practice Address - Phone:617-610-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022233103TC0700X
MA10350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical