Individual
MARY ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
8198-123
WI
1041C0700X
Clinical Social Worker
Primary
LCS29109
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16-59500882
—
WI
01
—
HE611A
MEDICARE PART B PROVIDER PTAN
CA
01
—
LCS29109
BOARD OF BEHAVIORAL SCIENCE
CA
01
—
LCSW 8198-123
STATE OF WISC-DEPT OF SAFETY & PROFESSIONAL SERVICES
WI
Enumeration date
07/09/2009
Last updated
04/09/2020
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