Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 9547 | MA |
NPI | 1053493429 |
---|---|
Provider Name | Catherine Glenn |
First Address | Woburn, MA 01801-1972 |
Second Address | Woburn, MA 01801-1972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 17/07/2012 |