Healthcare Provider Details

I. General information

NPI: 1427874262
Provider Name (Legal Business Name): WESLEY MATTHEW ALLEN ED. S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S EAST ST
FREDERICK MD
21701-5918
US

IV. Provider business mailing address

5611 5TH ST NW APT L3
WASHINGTON DC
20011-6540
US

V. Phone/Fax

Practice location:
  • Phone: 301-644-5000
  • Fax:
Mailing address:
  • Phone: 843-338-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: