Provider Demographics
NPI:1851829378
Name:LUGO, GLENNYS SORANGEL (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GLENNYS
Middle Name:SORANGEL
Last Name:LUGO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 EVERGREEN AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-3268
Mailing Address - Country:US
Mailing Address - Phone:646-321-3759
Mailing Address - Fax:
Practice Address - Street 1:1135 EVERGREEN AVE APT 2E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-3268
Practice Address - Country:US
Practice Address - Phone:646-321-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099779-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker