Provider Demographics
NPI:1053727826
Name:GLENN, MARGARET ROSE (LCSW,ACHP-SW)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LCSW,ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 US HIGHWAY 17
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4832
Mailing Address - Country:US
Mailing Address - Phone:904-236-0507
Mailing Address - Fax:904-269-0499
Practice Address - Street 1:4375 US HIGHWAY 17
Practice Address - Street 2:SUITE 103
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4832
Practice Address - Country:US
Practice Address - Phone:904-269-0886
Practice Address - Fax:904-269-0499
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW36661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical