Provider Demographics
NPI:1215777602
Name:BOONE, ALLEN LUTHER III (CRPA - P)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:LUTHER
Last Name:BOONE
Suffix:III
Gender:M
Credentials:CRPA - P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 SAINT MARYS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1857
Mailing Address - Country:US
Mailing Address - Phone:516-860-9845
Mailing Address - Fax:
Practice Address - Street 1:273 HEBERTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-1809
Practice Address - Country:US
Practice Address - Phone:718-412-3170
Practice Address - Fax:718-420-0514
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)