Provider Demographics
NPI:1497376594
Name:GLASS, CORTNEY C
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:C
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 GLENWAY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4188
Mailing Address - Country:US
Mailing Address - Phone:617-320-5941
Mailing Address - Fax:
Practice Address - Street 1:87 GLENWAY ST APT 3
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-4188
Practice Address - Country:US
Practice Address - Phone:617-320-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician