Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1053828848 |
---|---|
Provider Name | Mr. Daniel Jeremy Glass |
First Address | Darien, CT 06820-4732 |
Second Address | Darien, CT 06820-4732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 22/01/2020 |