Provider Demographics
NPI:1932800190
Name:ALLEN, RAY TERUE
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:TERUE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 FORT TOTTEN DR NE APT 36
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7574
Mailing Address - Country:US
Mailing Address - Phone:202-436-1367
Mailing Address - Fax:
Practice Address - Street 1:4860 FORT TOTTEN DR NE APT 36
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7574
Practice Address - Country:US
Practice Address - Phone:202-436-1367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator