Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 002414 | CT |
NPI | 1003043894 |
---|---|
Provider Name | Mr. Glenn Gregory Gemma |
First Address | Hartford, CT 06114-3081 |
Second Address | Hartford, CT 06114-3081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2009 |
Last Update Date | 26/10/2012 |