Provider Demographics
NPI:1194873208
Name:GLASS, CYNTHIA KAY (LCSW-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:GLASS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-3267
Mailing Address - Country:US
Mailing Address - Phone:301-260-1149
Mailing Address - Fax:301-260-8952
Practice Address - Street 1:1 SAINT GEORGE CT
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-3267
Practice Address - Country:US
Practice Address - Phone:301-260-1149
Practice Address - Fax:301-260-8952
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD996BCKOtherCAREFIRST MARYLAND
MD7797791Medicare UPIN
MD996BCKOtherCAREFIRST MARYLAND