Provider Demographics
NPI:1508916982
Name:GLATTER, MYLES (LICSW)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:GLATTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SMITHFIELD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-3336
Mailing Address - Country:US
Mailing Address - Phone:401-245-6891
Mailing Address - Fax:
Practice Address - Street 1:840 SMITHFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-3336
Practice Address - Country:US
Practice Address - Phone:401-245-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI366605OtherMAGELLAN HEALTH SERVICES
RIMG14006OtherEDS
RI1032050OtherBEACON HEALTH STRATEGIES