Provider Demographics
NPI:1356153746
Name:GLENN, DARLENE MICHELLE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MICHELLE
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 CINDERELLA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2066
Mailing Address - Country:US
Mailing Address - Phone:941-451-3626
Mailing Address - Fax:
Practice Address - Street 1:3723 CINDERELLA RD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-2066
Practice Address - Country:US
Practice Address - Phone:941-451-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL690082896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker