Provider Demographics
NPI:1003192006
Name:GLAZE, CARA M (LSW)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:M
Last Name:GLAZE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:CARA
Other - Middle Name:M
Other - Last Name:VENUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:551 CRABAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-8020
Mailing Address - Country:US
Mailing Address - Phone:614-653-0261
Mailing Address - Fax:
Practice Address - Street 1:1095 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4476
Practice Address - Country:US
Practice Address - Phone:740-848-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.20052231041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical