Provider Demographics
NPI:1417441304
Name:PEART, GLENRICK ALAN
Entity Type:Individual
Prefix:
First Name:GLENRICK
Middle Name:ALAN
Last Name:PEART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SCULPIN WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2664
Mailing Address - Country:US
Mailing Address - Phone:781-771-5489
Mailing Address - Fax:
Practice Address - Street 1:37 SCULPIN WAY APT 1
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2664
Practice Address - Country:US
Practice Address - Phone:781-771-5489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health