Provider Demographics
NPI:1700926250
Name:ALLEN, RONDEY (LICSW, LPN)
Entity Type:Individual
Prefix:MR
First Name:RONDEY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LICSW, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PARK AVE STE 205
Mailing Address - Street 2:STE 205
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3371
Mailing Address - Country:US
Mailing Address - Phone:413-732-7677
Mailing Address - Fax:413-732-7688
Practice Address - Street 1:117 PARK AVE STE 205
Practice Address - Street 2:STE 205
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3371
Practice Address - Country:US
Practice Address - Phone:413-732-7677
Practice Address - Fax:413-732-7688
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141561041C0700X
MA51684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No164W00000XNursing Service ProvidersLicensed Practical Nurse