Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003068701 |
---|---|
Provider Name | Jennifer Glass |
First Address | Hartford, CT 06105-2907 |
Second Address | Hartford, CT 06105-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2008 |
Last Update Date | 16/10/2008 |