MEDICARE: CHRISTINA ALLEN LICSW

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	089-00001085	VT

General Provider Information

NPI Number	:	1740336924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA ALLEN LICSW

Provider Business Mailing Address
First Line	:	595 DORSET ST STE 2
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6240
Country	:	US
Telephone Number	:	802-651-8999
Fax Number	:	802-651-8997

Provider Business Practice Location Address
First Line	:	595 DORSET ST STE 2
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6240
Country	:	US
Telephone Number	:	802-651-8999
Fax Number	:	802-651-8997

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	12/04/2019

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Directions to “ CHRISTINA ALLEN LICSW” Practice Location

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