Provider Demographics
NPI:1699830240
Name:DUMONT, ALLEN ANDRE (LCSW BCD)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:ANDRE
Last Name:DUMONT
Suffix:
Gender:M
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 219 ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2344
Mailing Address - Country:US
Mailing Address - Phone:718-224-4886
Mailing Address - Fax:718-224-4886
Practice Address - Street 1:3906 219 ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2344
Practice Address - Country:US
Practice Address - Phone:718-224-4886
Practice Address - Fax:718-224-4886
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01643511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000060Medicare ID - Type Unspecified