Provider Demographics
NPI:1255675278
Name:GLOVER, MARTHA B (LICSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BEACON ST STE 225
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3200
Mailing Address - Country:US
Mailing Address - Phone:617-332-2701
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST STE 225
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3200
Practice Address - Country:US
Practice Address - Phone:617-332-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical