Provider Demographics
NPI:1982867909
Name:GLENN, DEBORAH ANGELA (MSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANGELA
Last Name:GLENN
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 1:9 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2018
Mailing Address - Country:US
Mailing Address - Phone:914-668-9124
Mailing Address - Fax:914-668-0940
Practice Address - Street 1:9 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2018
Practice Address - Country:US
Practice Address - Phone:914-668-9124
Practice Address - Fax:914-668-0940
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251S00000XAgenciesCommunity/Behavioral Health