Provider Demographics
NPI:1770188237
Name:ALLEN, MICHAEL (LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAGNOLIA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8720
Mailing Address - Country:US
Mailing Address - Phone:857-373-9050
Mailing Address - Fax:
Practice Address - Street 1:10 MAGNOLIA ST APT 3
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8720
Practice Address - Country:US
Practice Address - Phone:857-373-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1239551041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical