Provider Demographics
NPI:1255811774
Name:LOEB, ALLISON ROSE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ROSE
Last Name:LOEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 NEWARK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3418
Mailing Address - Country:US
Mailing Address - Phone:908-758-4624
Mailing Address - Fax:
Practice Address - Street 1:258 NEWARK ST STE 208
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3418
Practice Address - Country:US
Practice Address - Phone:908-758-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104102104100000X
NY0928321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker