Provider Demographics
NPI:1386720266
Name:ALLEN, ANTHONY V (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:V
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:VAN PHUC
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1511
Mailing Address - Country:US
Mailing Address - Phone:213-629-6200
Mailing Address - Fax:
Practice Address - Street 1:529 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1511
Practice Address - Country:US
Practice Address - Phone:213-629-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 224751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical