Provider Demographics
NPI:1972859338
Name:GLASS, MATTHEW HOWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:HOWARD
Last Name:GLASS
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:9180 ESTERO PARK COMMONS BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3218
Mailing Address - Country:US
Mailing Address - Phone:239-839-5904
Mailing Address - Fax:239-495-7772
Practice Address - Street 1:17861 OAKMONT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-7202
Practice Address - Country:US
Practice Address - Phone:239-839-5904
Practice Address - Fax:239-362-3298
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSW 107071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical