Healthcare Provider Details

I. General information

NPI: 1255913927
Provider Name (Legal Business Name): LAURA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 ORCHARD ST
HASKELL NJ
07420-1324
US

IV. Provider business mailing address

13 ORCHARD ST
HASKELL NJ
07420-1324
US

V. Phone/Fax

Practice location:
  • Phone: 862-215-7994
  • Fax:
Mailing address:
  • Phone: 862-215-7994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

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: