Healthcare Provider Details

I. General information

NPI: 1780669358
Provider Name (Legal Business Name): HOWARD JOSEPH ALLEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 EDEN RD
NORTH COLLINS NY
14111-9738
US

IV. Provider business mailing address

11417 EDEN RD P.O. BOX 623
NORTH COLLINS NY
14111-9738
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3092
  • Fax: 716-337-3092
Mailing address:
  • Phone: 716-337-3092
  • Fax: 716-337-3092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: