MEDICARE: DR. VINCENT CASEY ALLEN JR. LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY004182	GA

General Provider Information

NPI Number	:	1174899371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT CASEY ALLEN JR. LP

Provider Business Mailing Address
First Line	:	1700 NORTHSIDE DR
Second Line	:	SUITE A7, UNIT #5110
City	:	ATLANTA
State	:	GA
Zip	:	30318
Country	:	US
Telephone Number	:	404-999-7605
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 W 45TH ST
Second Line	:	11TH FLOOR
City	:	NEW YORK CITY
State	:	NY
Zip	:	10036
Country	:	US
Telephone Number	:	404-999-7605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2012
Last Update Date	:	10/12/2023

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