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General NPI Number Information
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NPI Number | 1174899371
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Entity Type | Individual
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Provider Name | VINCENT CASEY ALLEN JR. LP
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Gender | Male
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Dates
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Enumeration Date | 04/01/2012
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 25 W 45TH ST 11TH FLOOR
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City | NEW YORK CITY
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State | NY
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Zip | 10036
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Country | US
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Telephone | 404-999-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 NORTHSIDE DR SUITE A7, UNIT #5110
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City | ATLANTA
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State | GA
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Zip | 30318
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Country | US
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Telephone | 404-999-7605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY004182
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License Number State | GA
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