Healthcare Provider Details

I. General information

NPI: 1114192333
Provider Name (Legal Business Name): ALLISON BALLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON STONE

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 NE 14TH ST SUITE 5
POMPANO BEACH FL
33062-3565
US

IV. Provider business mailing address

11576 PONYWALK TRL
BOYNTON BEACH FL
33473-7820
US

V. Phone/Fax

Practice location:
  • Phone: 954-603-7885
  • Fax: 954-342-0273
Mailing address:
  • Phone: 561-306-7570
  • Fax: 888-403-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: