Provider Demographics
NPI:1841503992
Name:ALLEN, IDA DARNELL JR (MASTERS DEGREE)
Entity type:Individual
Prefix:MISS
First Name:IDA
Middle Name:DARNELL
Last Name:ALLEN
Suffix:JR
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BAKER ST UNIT H
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1961
Mailing Address - Country:US
Mailing Address - Phone:857-334-0162
Mailing Address - Fax:
Practice Address - Street 1:95 BERKELEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6230
Practice Address - Country:US
Practice Address - Phone:617-778-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor