Healthcare Provider Details

I. General information

NPI: 1417621780
Provider Name (Legal Business Name): TERESA ANN ALLEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 DEEP WOOD DR
FORESTDALE MA
02644-2047
US

IV. Provider business mailing address

41 DEEP WOOD DR
FORESTDALE MA
02644-2047
US

V. Phone/Fax

Practice location:
  • Phone: 457-251-9984
  • Fax: 774-961-3587
Mailing address:
  • Phone: 457-251-9984
  • Fax: 774-961-3587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number236745
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN236745
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: