Provider Demographics
NPI:1124247515
Name:ALLEN, TANYA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32130-3027
Mailing Address - Country:US
Mailing Address - Phone:207-807-7191
Mailing Address - Fax:
Practice Address - Street 1:285 CLYDE MORRIS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8144
Practice Address - Country:US
Practice Address - Phone:239-690-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW228331041C0700X
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical