Healthcare Provider Details

I. General information

NPI: 1336271428
Provider Name (Legal Business Name): JOHN R ALLARD MS IN ED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE ROAD WAYNE BEHAVIORAL HEALTH NETWORK
LYONS NY
14489
US

IV. Provider business mailing address

6989 TUCKAHOE ROAD
WILLIAMSON NY
14589
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax: 315-946-7066
Mailing address:
  • Phone: 315-589-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number003060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: