Provider Demographics
NPI:1073729976
Name:STEVENSON, GLENN GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:GEORGE
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17662 IRVINE BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3132
Mailing Address - Country:US
Mailing Address - Phone:714-468-9963
Mailing Address - Fax:714-636-9696
Practice Address - Street 1:17662 IRVINE BLVD
Practice Address - Street 2:STE 7
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3132
Practice Address - Country:US
Practice Address - Phone:714-468-9963
Practice Address - Fax:714-636-9696
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2018-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS193981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical