Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist | MH2377 | FL |
NPI | 1013265933 |
---|---|
Provider Name | Dr. Mary Elizabeth Glass |
First Address | Ft Myers, FL 33912-7133 |
Second Address | Ft Myers, FL 33912-7133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 27/08/2012 |