Provider Demographics
NPI:1851663413
Name:ALLEN, SANDRA LEA (MS, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 BOUDINOT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5726
Mailing Address - Country:US
Mailing Address - Phone:513-481-2384
Mailing Address - Fax:513-481-4472
Practice Address - Street 1:3506 BOUDINOT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5726
Practice Address - Country:US
Practice Address - Phone:513-481-2384
Practice Address - Fax:513-481-4472
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00070211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical