Provider Demographics
NPI:1396110789
Name:GLENSHAW, BRIDGET ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:GLENSHAW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BRIDGET
Other - Middle Name:ELIZABETH
Other - Last Name:GLENSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:21 PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1812
Mailing Address - Country:US
Mailing Address - Phone:781-861-7081
Mailing Address - Fax:781-861-3625
Practice Address - Street 1:187 SPRING ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8030
Practice Address - Country:US
Practice Address - Phone:781-861-7081
Practice Address - Fax:781-861-3625
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4083101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health