Provider Demographics
NPI:1669648069
Name:LIVINGSTONE, ALLYSON NICHELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NICHELLE
Last Name:LIVINGSTONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BELMONT SQ
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2505
Mailing Address - Country:US
Mailing Address - Phone:617-905-5009
Mailing Address - Fax:
Practice Address - Street 1:1130 MASSACHUSETTS AVE
Practice Address - Street 2:FLOOR 3
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5204
Practice Address - Country:US
Practice Address - Phone:617-905-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical