Provider Demographics
NPI:1003043894
Name:GEMMA, GLENN GREGORY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:GREGORY
Last Name:GEMMA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3081
Mailing Address - Country:US
Mailing Address - Phone:860-756-8669
Mailing Address - Fax:
Practice Address - Street 1:555 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3081
Practice Address - Country:US
Practice Address - Phone:860-756-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0024141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical