Provider Demographics
NPI:1821528878
Name:ALLEN, DANIELLE R (LCSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 GREEN HOLLY CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-2018
Mailing Address - Country:US
Mailing Address - Phone:260-750-0341
Mailing Address - Fax:
Practice Address - Street 1:1027 W RUDISILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-2160
Practice Address - Country:US
Practice Address - Phone:260-750-0341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008768A1041C0700X
IN33008546A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical