Provider Demographics
NPI:1023235843
Name:BROWN, GLENN TORRE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:TORRE
Last Name:BROWN
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:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-0479
Mailing Address - Country:US
Mailing Address - Phone:516-616-3033
Mailing Address - Fax:516-873-8881
Practice Address - Street 1:448 LAKESHORE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4264
Practice Address - Country:US
Practice Address - Phone:803-328-9600
Practice Address - Fax:803-329-7141
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC303272163WP0808X
NY0751951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3339OtherMEDICARE
SC1568476885Medicaid