Provider Demographics
NPI:1780081737
Name:GLENNON, ALEXIS S (LCSW)
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:S
Last Name:GLENNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 STATE ROUTE 90
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:13026-8680
Mailing Address - Country:US
Mailing Address - Phone:315-730-7561
Mailing Address - Fax:
Practice Address - Street 1:33 WILLIAM ST STE 7
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3730
Practice Address - Country:US
Practice Address - Phone:315-730-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical