Provider Demographics
NPI:1720186505
Name:ANDERSON, ALLAN NEIL (LICSW)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:NEIL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4338
Mailing Address - Country:US
Mailing Address - Phone:978-937-2696
Mailing Address - Fax:978-970-2922
Practice Address - Street 1:704 ROGERS ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4338
Practice Address - Country:US
Practice Address - Phone:978-937-2696
Practice Address - Fax:978-970-2922
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA712815OtherTUFTS HEALTH PLANS
MAP04692OtherBLUE CROSS BLUE SHIELD
MAP22239Medicare ID - Type Unspecified