Provider Demographics
NPI:1326348459
Name:GLENNON, JAMES RORY (PSYD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RORY
Last Name:GLENNON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ROSE
Other - Last Name:GLENNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1 WAHOO AVE
Mailing Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-4966
Mailing Address - Fax:860-694-2101
Practice Address - Street 1:1 WAHOO AVE
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5600
Practice Address - Country:US
Practice Address - Phone:860-694-4966
Practice Address - Fax:860-694-2101
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 390200000X
CT003383103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program