Healthcare Provider Details

I. General information

NPI: 1336110790
Provider Name (Legal Business Name): DEANNA LEANNE NUTTBROCK-ALLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG UNIT 5210 BOX 230
APO AE
09461
GB

IV. Provider business mailing address

55 MACPHERSON ROBERTSON WAY
MILDENHALL SUFFOLK
IP28 7RS
GB

V. Phone/Fax

Practice location:
  • Phone: 01638543308
  • Fax:
Mailing address:
  • Phone: 07789746927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY00002982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: