Healthcare Provider Details

I. General information

NPI: 1063956316
Provider Name (Legal Business Name): JONATHAN C. ALLEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85A WALL STREET
MADISON CT
06443
US

IV. Provider business mailing address

85A WALL STREET
MADISON CT
06443
US

V. Phone/Fax

Practice location:
  • Phone: 860-378-7841
  • Fax:
Mailing address:
  • Phone: 860-378-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number041054
License Number StateCT

VIII. Authorized Official

Name: DR. JONATHAN C. ALLEN
Title or Position: OWNER/MD
Credential: MD
Phone: 860-378-7841