Individual provider Active NPI

Kenneth R Allen, MSW, LCSW-C

  • Clinical Social Worker
  • Pasadena, MD
National Provider Identifier
1114005063
Registry record updated Nov 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
06873 Issued in MD
Practice address
8131 Ritchie Hwy Ste G
Pasadena, MD 21122-6940
Phone
(410) 544-4927
Fax
(410) 544-4928
NPI assigned
Nov 1, 2006
Last updated
Nov 15, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 06873 MD Primary

Addresses

Primary practice location

8131 Ritchie Hwy Ste G
Pasadena, MD 21122-6940

Mailing address

8131 Ritchie Hwy Ste G
Pasadena, MD 21122-6940
Phone (410) 544-4927

Other identifiers 1

IdentifierTypeStateIssuer
503P984GOtherMDMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06873MDMDPsychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1114005063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8131 RITCHIE HWY STE G",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211226940",
            "telephone_number": "410-544-4927",
            "fax_number": "410-544-4928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8131 RITCHIE HWY STE G",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211226940",
            "telephone_number": "410-544-4927",
            "fax_number": "410-544-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "KENNETH",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "MSW, LCSW-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "06873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "503P984G",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.