Provider Demographics
NPI:1689429235
Name:ALLEN, AUTUMN (MSW, MS)
Entity type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:
Credentials:MSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 JEFFREYS WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6149
Mailing Address - Country:US
Mailing Address - Phone:603-834-4263
Mailing Address - Fax:
Practice Address - Street 1:1045 ELM ST STE 20
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1821
Practice Address - Country:US
Practice Address - Phone:203-747-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator