Provider Demographics
NPI:1518323021
Name:GLOVER, IRENA J (PHD, LMSW)
Entity Type:Individual
Prefix:DR
First Name:IRENA
Middle Name:J
Last Name:GLOVER
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W GRAND BLVD STE 1507
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3000
Mailing Address - Country:US
Mailing Address - Phone:313-608-9512
Mailing Address - Fax:313-462-4829
Practice Address - Street 1:3011 W GRAND BLVD STE 1507
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3000
Practice Address - Country:US
Practice Address - Phone:313-608-9512
Practice Address - Fax:313-462-4829
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085755106H00000X, 1041C0700X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker