Healthcare Provider Details

I. General information

NPI: 1043649122
Provider Name (Legal Business Name): AMY ALLEN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 ENTERPRISE DRIVE #105
WINDHAM NH
03087-0308
US

IV. Provider business mailing address

47 ENTERPRISE DR # 105
WINDHAM NH
03087-2032
US

V. Phone/Fax

Practice location:
  • Phone: 603-845-1868
  • Fax:
Mailing address:
  • Phone: 603-845-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1752
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: