Provider Demographics
NPI:1710019682
Name:GLISSON, ANGELA E (MSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:E
Last Name:GLISSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LOPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 ROWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4943
Mailing Address - Country:US
Mailing Address - Phone:781-437-1323
Mailing Address - Fax:
Practice Address - Street 1:126 COVE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-1357
Practice Address - Country:US
Practice Address - Phone:508-678-0041
Practice Address - Fax:508-324-9002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA6408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685661OtherTUFTS
MAM18708OtherBLUE CROSS
MA1312677Medicaid
MA1312677Medicaid