Healthcare Provider Details

I. General information

NPI: 1356968135
Provider Name (Legal Business Name): ALLISON LONDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 WASHINGTON ST
WATERTOWN NY
13601-9371
US

IV. Provider business mailing address

11050 MOUNT BELVEDERE BLVD
FORT DRUM NY
13602-5438
US

V. Phone/Fax

Practice location:
  • Phone: 315-779-5060
  • Fax: 315-779-5028
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097793
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: