Healthcare Provider Details

I. General information

NPI: 1053853531
Provider Name (Legal Business Name): CAROLYN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 TALL TOP DR
TALLAHASSEE FL
32305-8389
US

IV. Provider business mailing address

521 TALL TOP DR
TALLAHASSEE FL
32305-8389
US

V. Phone/Fax

Practice location:
  • Phone: 850-980-2804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1143501.
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25653
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: