Provider Demographics
NPI:1700200995
Name:GLANVILLE, CINDY LEE
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:GLANVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:GLANVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW-R
Mailing Address - Street 1:108 S. ALBANY ST
Mailing Address - Street 2:BETTER LIFE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-256-1167
Mailing Address - Fax:607-255-6681
Practice Address - Street 1:108 S. ALBANY ST.
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-256-1167
Practice Address - Fax:607-255-6681
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035751-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27-4649614OtherGROUP PRIVATE PRACTICE