Provider Demographics
NPI:1679153886
Name:ALLEN, JESSE (LMHC)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 OCEAN SPRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3233
Mailing Address - Country:US
Mailing Address - Phone:518-232-2380
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4119
Practice Address - Country:US
Practice Address - Phone:401-728-1800
Practice Address - Fax:401-728-0182
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health