Provider Demographics
NPI:1033674437
Name:GLISSON, ABBY (REGISTERED INTERN)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:GLISSON
Suffix:
Gender:F
Credentials:REGISTERED INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 W LINEBAUGH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5824
Mailing Address - Country:US
Mailing Address - Phone:813-833-3201
Mailing Address - Fax:
Practice Address - Street 1:6938 W LINEBAUGH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5824
Practice Address - Country:US
Practice Address - Phone:813-833-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW132871041C0700X
FL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical