Provider Demographics
NPI:1063891489
Name:GLENN, JAMES E JR (LSW)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:GLENN
Suffix:JR
Gender:M
Credentials:LSW
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 AVONDALE RD PH 1
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6676
Mailing Address - Country:US
Mailing Address - Phone:610-955-2729
Mailing Address - Fax:
Practice Address - Street 1:800 AVONDALE RD PH 1
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6676
Practice Address - Country:US
Practice Address - Phone:610-955-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker