Healthcare Provider Details

I. General information

NPI: 1730722059
Provider Name (Legal Business Name): JOSHUA KLEIN ALLEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 JONES RD
MACCLENNY FL
32063-2554
US

IV. Provider business mailing address

44 JONES RD
MACCLENNY FL
32063-2554
US

V. Phone/Fax

Practice location:
  • Phone: 904-294-6681
  • Fax:
Mailing address:
  • Phone: 904-294-6681
  • Fax: 904-259-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW19314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: