Provider Demographics
NPI:1275192296
Name:PETOK, ALISON (LICSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:PETOK
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PAYSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3216
Mailing Address - Country:US
Mailing Address - Phone:410-804-9638
Mailing Address - Fax:
Practice Address - Street 1:3 PAYSON RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3216
Practice Address - Country:US
Practice Address - Phone:410-804-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC229201041C0700X
MA1227591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical