Provider Demographics
NPI:1891145819
Name:GLYNN, JESSICA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:GLYNN
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 1:535 5TH AVE FL 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3689
Mailing Address - Country:US
Mailing Address - Phone:917-727-1435
Mailing Address - Fax:
Practice Address - Street 1:136 MADISON AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6711
Practice Address - Country:US
Practice Address - Phone:646-661-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0887211041C0700X
NY0977841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical