Provider Demographics
NPI:1023155421
Name:RHINE, GLENN GARY (LCSW)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:GARY
Last Name:RHINE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 MAINSAIL DR UNIT 1712
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-8808
Mailing Address - Country:US
Mailing Address - Phone:239-404-6383
Mailing Address - Fax:
Practice Address - Street 1:997 N COLLIER BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2773
Practice Address - Country:US
Practice Address - Phone:239-404-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000166A1041C0700X
FLSW94951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800007180OtherRAILROAD MEDICARE
IN125390IMedicare ID - Type Unspecified