Basic Information
| Provider Information | |||||||||
| NPI: | 1598812554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | PAULINE | ||||||||
| MiddleName: | WITT | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 BEACH ST | ||||||||
| Address2: | |||||||||
| City: | BROCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144201801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856377773 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14014 STATE ROUTE 31 | ||||||||
| Address2: | |||||||||
| City: | ALBION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144119301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855897066 | ||||||||
| FaxNumber: | 5855896395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 073072-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.