Provider Demographics
NPI:1649488834
Name:TROTTER GLYNN, DENISE LAVERNE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:LAVERNE
Last Name:TROTTER GLYNN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:LAVERNE
Other - Last Name:TROTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1300 MERCANTILE LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5327
Mailing Address - Country:US
Mailing Address - Phone:301-512-4689
Mailing Address - Fax:301-773-1052
Practice Address - Street 1:721 E PATAPSCO AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1934
Practice Address - Country:US
Practice Address - Phone:301-512-4689
Practice Address - Fax:301-773-1052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD098501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09850OtherLCSW-C