Provider Demographics
NPI:1003969015
Name:GLOSSER, CYNTHIA ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:GLOSSER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:BOUDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:16 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2011
Mailing Address - Country:US
Mailing Address - Phone:603-889-8781
Mailing Address - Fax:603-889-0272
Practice Address - Street 1:16 BROAD ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2011
Practice Address - Country:US
Practice Address - Phone:603-889-8781
Practice Address - Fax:603-889-0272
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423077Medicaid