Provider Demographics
NPI:1902181324
Name:PENALOZA, ALLYSON MARIE (INTERN)
Entity Type:Individual
Prefix:MS
First Name:ALLYSON
Middle Name:MARIE
Last Name:PENALOZA
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:MS
Other - First Name:ALLYSON
Other - Middle Name:MARIE
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:INTERN
Mailing Address - Street 1:800 CUMMINGS CTR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6175
Mailing Address - Country:US
Mailing Address - Phone:978-921-1190
Mailing Address - Fax:
Practice Address - Street 1:800 CUMMINGS CENTER
Practice Address - Street 2:NORTHEAST BEHAVIORAL HEALTH
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor