Healthcare Provider Details

I. General information

NPI: 1871114041
Provider Name (Legal Business Name): LAURIE ALLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 WOLFPIT AVE
NORWALK CT
06851-3436
US

IV. Provider business mailing address

120 EAST AVE
NORWALK CT
06851-5703
US

V. Phone/Fax

Practice location:
  • Phone: 203-846-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number064952
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number257
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: