Provider Demographics
NPI:1740273655
Name:FINEMAN, GLEN H (LCSW)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:H
Last Name:FINEMAN
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 1:12818 AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3733
Mailing Address - Country:US
Mailing Address - Phone:402-334-1122
Mailing Address - Fax:402-334-8171
Practice Address - Street 1:12818 AUGUSTA AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3733
Practice Address - Country:US
Practice Address - Phone:402-334-1122
Practice Address - Fax:402-334-8171
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE852104100000X
NE230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076860626Medicaid
NE47076860626Medicaid