Provider Demographics
NPI:1871769323
Name:ALLEN, ROGER EVERETT (LMHC)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:EVERETT
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-0225
Mailing Address - Country:US
Mailing Address - Phone:774-323-0251
Mailing Address - Fax:
Practice Address - Street 1:3937 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1592
Practice Address - Country:US
Practice Address - Phone:508-237-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health