Provider Demographics
NPI:1093834731
Name:GLOVER, SWGOTRETSE RACEY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SWGOTRETSE
Middle Name:RACEY
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E 93RD ST
Mailing Address - Street 2:APT.# D311
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2353
Mailing Address - Country:US
Mailing Address - Phone:718-636-5279
Mailing Address - Fax:718-636-5517
Practice Address - Street 1:1360 FULTON ST
Practice Address - Street 2:SUITE 502
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2636
Practice Address - Country:US
Practice Address - Phone:718-636-5279
Practice Address - Fax:718-636-5517
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X283Q00000X
NYF342707-01363LF0000X
NY664571-01163W00000X
NY071976-1R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No283Q00000XHospitalsPsychiatric Hospital
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse