Provider Demographics
NPI:1649056078
Name:GERROL, EMMA GLENN (LCSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:GLENN
Last Name:GERROL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1936
Mailing Address - Country:US
Mailing Address - Phone:207-661-3600
Mailing Address - Fax:207-761-0783
Practice Address - Street 1:37 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1936
Practice Address - Country:US
Practice Address - Phone:207-661-3600
Practice Address - Fax:207-761-0783
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30541041C0700X
MELC241941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical