Provider Demographics
NPI:1730153651
Name:GLASS, RAWLAND D (MSW LCSW)
Entity type:Individual
Prefix:MR
First Name:RAWLAND
Middle Name:D
Last Name:GLASS
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4705
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0192
Mailing Address - Country:US
Mailing Address - Phone:541-282-7814
Mailing Address - Fax:541-245-2633
Practice Address - Street 1:1050 CRATER LAKE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6223
Practice Address - Country:US
Practice Address - Phone:541-282-7814
Practice Address - Fax:541-245-2633
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR 133745Medicare PIN