Provider Demographics
NPI:1013334382
Name:ALLEN, RONALD (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LINNAEAN ST
Mailing Address - Street 2:APARTMENT 11
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1573
Mailing Address - Country:US
Mailing Address - Phone:617-694-1080
Mailing Address - Fax:617-738-1247
Practice Address - Street 1:40 LINNAEAN ST
Practice Address - Street 2:APARTMENT 11
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1573
Practice Address - Country:US
Practice Address - Phone:617-694-1080
Practice Address - Fax:617-738-1247
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-09-5698103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst