Provider Demographics
NPI:1629410311
Name:KING-ALLEN, NATASHA NICOLE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:NICOLE
Last Name:KING-ALLEN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SHORE BLVD
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4030
Mailing Address - Country:US
Mailing Address - Phone:347-451-2861
Mailing Address - Fax:
Practice Address - Street 1:40 SHORE BLVD
Practice Address - Street 2:APARTMENT 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4030
Practice Address - Country:US
Practice Address - Phone:347-451-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY742502222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist