Provider Demographics
NPI:1881739951
Name:ANDERSON, GLENDA LEE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MIDSTATE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1878
Mailing Address - Country:US
Mailing Address - Phone:508-832-5800
Mailing Address - Fax:
Practice Address - Street 1:15 MIDSTATE DR STE 206
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1878
Practice Address - Country:US
Practice Address - Phone:508-832-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health