Healthcare Provider Details

I. General information

NPI: 1386789774
Provider Name (Legal Business Name): MARK E. ALLARD LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4364 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

IV. Provider business mailing address

43 SOWAMS RD
BARRINGTON RI
02806-4602
US

V. Phone/Fax

Practice location:
  • Phone: 508-998-2700
  • Fax: 508-998-2176
Mailing address:
  • Phone: 508-998-2700
  • Fax: 508-998-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016646
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: