Provider Demographics
NPI:1376882274
Name:GLENN, CATAROLYN MICHELLE (MA)
Entity Type:Individual
Prefix:MS
First Name:CATAROLYN
Middle Name:MICHELLE
Last Name:GLENN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 BENJAMIN RD
Mailing Address - Street 2:D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-1224
Mailing Address - Country:US
Mailing Address - Phone:813-872-8521
Mailing Address - Fax:813-200-3707
Practice Address - Street 1:8509 BENJAMIN RD
Practice Address - Street 2:D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1224
Practice Address - Country:US
Practice Address - Phone:813-872-8521
Practice Address - Fax:813-200-3707
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679096896-67Medicaid