Provider Demographics
NPI:1154468148
Name:GLENN, ROBERT T (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:GLENN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 OAK FOREST BLVD N
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3413
Mailing Address - Country:US
Mailing Address - Phone:727-392-7554
Mailing Address - Fax:
Practice Address - Street 1:5444 PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3300
Practice Address - Country:US
Practice Address - Phone:727-698-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 0168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist