MEDICARE: JUDITH LYNN ALLEN MSW, LCSW

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	1041C0700X	Clinical Social Worker	SW7092	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11845436	OTHER	FL	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	SW7092	OTHER	FL	DOH LICENSE #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366655789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH LYNN ALLEN MSW, LCSW

Provider Business Mailing Address
First Line	:	1631 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4809
Country	:	US
Telephone Number	:	407-644-5437
Fax Number	:	407-270-2433

Provider Business Practice Location Address
First Line	:	1631 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4809
Country	:	US
Telephone Number	:	407-644-5437
Fax Number	:	407-270-2433

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/21/2022

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