Healthcare Provider Details

I. General information

NPI: 1578259933
Provider Name (Legal Business Name): ROBERT ALLOSSO M.KIN, M.S.W., LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 ELM ST
MANCHESTER NH
03104-2528
US

IV. Provider business mailing address

2013 ELM ST
MANCHESTER NH
03104-2528
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2822
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: