Healthcare Provider Details

I. General information

NPI: 1578626461
Provider Name (Legal Business Name): ALLYSON BARBATO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLYSON SPENCER LCSW

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E BEAVER AVE SUITE 2
STATE COLLEGE PA
16801-4969
US

IV. Provider business mailing address

128 WAYPOINT CIR
STATE COLLEGE PA
16801-6261
US

V. Phone/Fax

Practice location:
  • Phone: 814-409-7744
  • Fax: 814-753-4584
Mailing address:
  • Phone: 631-389-2853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075486
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018848
License Number StatePA

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: