MEDICARE: MISS CHRISTINA MARIE ALLEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	007797	CT

General Provider Information

NPI Number	:	1174883011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINA MARIE ALLEN LCSW

Provider Business Mailing Address
First Line	:	14 WEBER ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-1436
Country	:	US
Telephone Number	:	203-605-8737
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WEBER ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-1436
Country	:	US
Telephone Number	:	203-605-8737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/25/2012

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