Provider Demographics
NPI:1952654147
Name:OLIVARES LONARDO, GLENDA C (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:C
Last Name:OLIVARES LONARDO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-2210
Mailing Address - Country:US
Mailing Address - Phone:978-794-3411
Mailing Address - Fax:
Practice Address - Street 1:40 WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2210
Practice Address - Country:US
Practice Address - Phone:978-794-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health