Provider Demographics
NPI:1386896629
Name:KIDD, ALLISON RACHEL (LISW-S)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RACHEL
Last Name:KIDD
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:RACHEL
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4930 ENTERPRISE DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-8706
Mailing Address - Country:US
Mailing Address - Phone:330-787-0955
Mailing Address - Fax:
Practice Address - Street 1:4930 ENTERPRISE DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-8706
Practice Address - Country:US
Practice Address - Phone:330-787-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17001981041C0700X
NY0838961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical