Individual
TISHEKA ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
423 HUDSON BLVD, AVENEL, NJ 07001-1310
(616) 644-5051
Mailing address
423 HUDSON BLVD, AVENEL, NJ 07001-1310
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06647300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44SL06647300
—
NJ
Enumeration date
10/04/2021
Last updated
10/04/2021
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