Provider Demographics
NPI:1245258227
Name:ALLEN, LINDA ANNE (RN, MFCC)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN, MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LONG CT STE A
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-7418
Mailing Address - Country:US
Mailing Address - Phone:805-493-1083
Mailing Address - Fax:805-439-1083
Practice Address - Street 1:86 LONG CT STE A
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7418
Practice Address - Country:US
Practice Address - Phone:805-493-1083
Practice Address - Fax:805-439-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN211357364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ95952ZOtherBLUE SHIELD
CAZZZ95952ZOtherBLUE SHIELD