Provider Demographics
NPI:1629549332
Name:ALLEN, SETH EDWARD
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:EDWARD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13521 DAVINCI LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6104
Mailing Address - Country:US
Mailing Address - Phone:120-266-9543
Mailing Address - Fax:
Practice Address - Street 1:13521 DAVINCI LN
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6104
Practice Address - Country:US
Practice Address - Phone:202-669-5431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040092651041C0700X
DCLC500790651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty