Provider Demographics
NPI:1851311633
Name:DEGROOT, ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DEGROOT
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 1:1060 WALDORF TERRACE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5546
Mailing Address - Country:US
Mailing Address - Phone:973-696-5668
Mailing Address - Fax:973-305-8078
Practice Address - Street 1:11 COLBURN CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8211
Practice Address - Country:US
Practice Address - Phone:973-696-5668
Practice Address - Fax:973-305-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL052303001041C0700X
NJ44SC052800001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical