Provider Demographics
NPI:1508945320
Name:VOYTOVICH, GLENNA ELIZABETH (MA MFT)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:ELIZABETH
Last Name:VOYTOVICH
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:GLENNA
Other - Middle Name:ELIZABETH
Other - Last Name:MIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA MFT
Mailing Address - Street 1:333 SCOTT SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3414
Mailing Address - Country:US
Mailing Address - Phone:860-676-2418
Mailing Address - Fax:203-583-3924
Practice Address - Street 1:333 SCOTT SWAMP RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-3414
Practice Address - Country:US
Practice Address - Phone:860-676-2418
Practice Address - Fax:203-583-3924
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410000541CT02OtherBLUE CROSS BLUE SHIELD