Provider Demographics
NPI:1003945163
Name:GLASS, RENEE S (LMSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:S
Last Name:GLASS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:SUE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:49590 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2332
Mailing Address - Country:US
Mailing Address - Phone:734-560-7931
Mailing Address - Fax:
Practice Address - Street 1:5958 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2765
Practice Address - Country:US
Practice Address - Phone:734-737-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802059052104100000X, 251S00000X
MI68010971751041C0700X
MI68010971761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health