Provider Demographics
NPI:1790473734
Name:ALLEN, DEJANAE L
Entity Type:Individual
Prefix:
First Name:DEJANAE
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LOCUST PL NE APT 2286
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1670
Mailing Address - Country:US
Mailing Address - Phone:346-575-9172
Mailing Address - Fax:
Practice Address - Street 1:801 LOCUST PL NE APT 2286
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1670
Practice Address - Country:US
Practice Address - Phone:346-575-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician