Provider Demographics
NPI:1295791655
Name:ALLEN, JACQUELINE (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MONARCH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1874
Mailing Address - Country:US
Mailing Address - Phone:859-219-0089
Mailing Address - Fax:859-219-0059
Practice Address - Street 1:1029 MONARCH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1874
Practice Address - Country:US
Practice Address - Phone:859-219-0089
Practice Address - Fax:859-219-0059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCSW0233Medicare ID - Type UnspecifiedLCSW