Healthcare Provider Details

I. General information

NPI: 1578583126
Provider Name (Legal Business Name): BEVERLY L ALLEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645A N MAIN ST
DANIELSON CT
06239-2108
US

IV. Provider business mailing address

27 PATRIOTS SQ
MANSFIELD CENTER CT
06250-1517
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-2122
  • Fax: 860-779-2123
Mailing address:
  • Phone: 860-456-1770
  • Fax: 860-779-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002718
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1043604
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCIGNA 03
# 2
Identifier079437
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerMHN
# 3
Identifier11230415
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerMULTIPLAN 03
# 4
IdentifierP2806130
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerOXFORD
# 5
Identifier244533
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerMAGELLAN, CLINICAL SOCIAL
# 6
Identifier134345
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerVALUE OPTIONS 03
# 7
IdentifierOOO7666432
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: