Provider Demographics
NPI:1740888916
Name:GLYNN, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAVE
Other - Middle Name:
Other - Last Name:GLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:254 FRANKLIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1932
Mailing Address - Country:US
Mailing Address - Phone:716-551-7894
Mailing Address - Fax:716-840-9593
Practice Address - Street 1:254 FRANKLIN ST FL 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1932
Practice Address - Country:US
Practice Address - Phone:716-551-7894
Practice Address - Fax:716-840-9593
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor