Provider Demographics
NPI:1689704884
Name:ALLEN, BENNETT THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:THOMAS
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 SKOKIE BLVD
Mailing Address - Street 2:304
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4019
Mailing Address - Country:US
Mailing Address - Phone:847-205-9605
Mailing Address - Fax:847-564-8755
Practice Address - Street 1:899 SKOKIE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4019
Practice Address - Country:US
Practice Address - Phone:847-205-9605
Practice Address - Fax:847-564-8755
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical