Provider Demographics
NPI:1760599716
Name:GLOW-MORGAN, KATHLEEN SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:GLOW-MORGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13122-9757
Mailing Address - Country:US
Mailing Address - Phone:315-662-7726
Mailing Address - Fax:
Practice Address - Street 1:9 ALBANY ST
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1201
Practice Address - Country:US
Practice Address - Phone:315-265-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056230-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY385409Medicare UPIN