Provider Demographics
NPI:1215056312
Name:GLAVAN, DENNIS R (MSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:GLAVAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 MONTANA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3275
Mailing Address - Country:US
Mailing Address - Phone:505-753-5442
Mailing Address - Fax:
Practice Address - Street 1:714 CALLE DON DIEGO
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3414
Practice Address - Country:US
Practice Address - Phone:505-367-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-08951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97282Medicaid