Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 63016867 | NY |
N | 225XM0800X | Mental Health | 63016867 | NY |
NPI | 1861796500 |
---|---|
Provider Name | Simone Allen |
First Address | New York, NY 10003-3851 |
Second Address | New York, NY 10003-3851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 08/07/2013 |