Provider Demographics
NPI:1083871636
Name:JAMES, GLENDA CAROL (DSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:CAROL
Last Name:JAMES
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081
Mailing Address - Country:US
Mailing Address - Phone:973-376-6214
Mailing Address - Fax:
Practice Address - Street 1:117119 ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-756-6870
Practice Address - Fax:908-756-5566
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0385781104100000X
NJ44SC012713001041C0700X
DCLC3004571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker