Provider Demographics
NPI:1104595404
Name:ALLEN, LASARA FIREFOX (MSW)
Entity type:Individual
Prefix:
First Name:LASARA
Middle Name:FIREFOX
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E STANDLEY ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4414
Mailing Address - Country:US
Mailing Address - Phone:707-466-0001
Mailing Address - Fax:
Practice Address - Street 1:280 E STANDLEY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4414
Practice Address - Country:US
Practice Address - Phone:707-466-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker