Provider Demographics
NPI:1417024787
Name:ANDREWS, GLENA LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENA
Middle Name:LYNNE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GLENA
Other - Middle Name:LYNNE NEEDHAM
Other - Last Name:SCHUBARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PSC 41 BOX 3567
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464-0036
Mailing Address - Country:US
Mailing Address - Phone:314-226-8293
Mailing Address - Fax:
Practice Address - Street 1:48 SGCS
Practice Address - Street 2:UNIT 5115 BLG 932
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464
Practice Address - Country:US
Practice Address - Phone:314-226-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2560103TC0700X, 103TH0100X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service