Provider Demographics
NPI:1548691272
Name:GLENN, CHRISTINA (CASAC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1400
Mailing Address - Country:US
Mailing Address - Phone:845-798-7984
Mailing Address - Fax:845-267-2174
Practice Address - Street 1:140 ROUTE 303
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989
Practice Address - Country:US
Practice Address - Phone:845-267-2172
Practice Address - Fax:845-267-2174
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6062101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor