Provider Demographics
NPI:1962633065
Name:ALLEN, CHERYL D
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
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 1:57407 29 PALMS HWY STE F
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2907
Mailing Address - Country:US
Mailing Address - Phone:760-366-1541
Mailing Address - Fax:
Practice Address - Street 1:57407 29 PALMS HWY STE F
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2907
Practice Address - Country:US
Practice Address - Phone:760-366-1541
Practice Address - Fax:760-288-1614
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW706251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical