Provider Demographics
NPI:1194772004
Name:CARR-ALLEN, VIVIAN (LCSW)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:CARR-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 1:36 WELLES ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2080
Mailing Address - Country:US
Mailing Address - Phone:860-652-0472
Mailing Address - Fax:860-652-3431
Practice Address - Street 1:36 WELLES ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2080
Practice Address - Country:US
Practice Address - Phone:860-652-0472
Practice Address - Fax:860-652-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002546103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800003858Medicare PIN