Provider Demographics
NPI:1528319415
Name:WOOD, GLYNNIS ELISE
Entity type:Individual
Prefix:
First Name:GLYNNIS
Middle Name:ELISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NAVESINK AVENUE
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760
Mailing Address - Country:US
Mailing Address - Phone:908-489-0131
Mailing Address - Fax:
Practice Address - Street 1:50 NAVESINK AVENUE
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760
Practice Address - Country:US
Practice Address - Phone:908-489-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool