Healthcare Provider Details

I. General information

NPI: 1396218327
Provider Name (Legal Business Name): ALLISON TRACY NEGRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 IRVING ST
WORCESTER MA
01609-2467
US

IV. Provider business mailing address

110 MCCORMICK RD
SPENCER MA
01562-1228
US

V. Phone/Fax

Practice location:
  • Phone: 508-799-3175
  • Fax:
Mailing address:
  • Phone: 339-234-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number405849
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: