Provider Demographics
NPI:1316589930
Name:GLENN, DAIMON A (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAIMON
Middle Name:A
Last Name:GLENN
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 CINDERELLA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2066
Mailing Address - Country:US
Mailing Address - Phone:646-418-8598
Mailing Address - Fax:
Practice Address - Street 1:3723 CINDERELLA RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-2066
Practice Address - Country:US
Practice Address - Phone:646-418-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty