Healthcare Provider Details

I. General information

NPI: 1396557005
Provider Name (Legal Business Name): LARRAINE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 EMROSE DR
PITTSBURGH PA
15235-3035
US

IV. Provider business mailing address

208 EMROSE DR
PITTSBURGH PA
15235-3035
US

V. Phone/Fax

Practice location:
  • Phone: 412-864-5084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN524061L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN524061L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: