Basic Information
Provider Information
NPI: 1548390925
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLEGRO
FirstName: DEANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1915 MCKEAN ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191452804
CountryCode: US
TelephoneNumber: 2155083300
FaxNumber: 2155083210
Practice Location
Address1: 90 ROCHELLE AVE
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191283808
CountryCode: US
TelephoneNumber: 2155083300
FaxNumber: 2155083210
Other Information
ProviderEnumerationDate: 03/06/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500XDN003537PAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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