Provider Demographics
NPI:1922199157
Name:GLASS, LOIS M (MSW)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:M
Last Name:GLASS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6204
Mailing Address - Country:US
Mailing Address - Phone:781-862-0982
Mailing Address - Fax:
Practice Address - Street 1:305 NEWBURY ST
Practice Address - Street 2:SUITE 41
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2833
Practice Address - Country:US
Practice Address - Phone:781-862-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical