Provider Demographics
NPI:1215299128
Name:GLYNN, KAREN MARY (MS ED)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARY
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1432
Mailing Address - Country:US
Mailing Address - Phone:516-766-0952
Mailing Address - Fax:
Practice Address - Street 1:1276 SURREY LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1432
Practice Address - Country:US
Practice Address - Phone:516-766-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1887113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist