Provider Demographics
NPI:1285101212
Name:GLOVER, PENNY (LCPC-C)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 LIBBY AVE
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2652
Mailing Address - Country:US
Mailing Address - Phone:207-754-3442
Mailing Address - Fax:
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9089
Practice Address - Country:US
Practice Address - Phone:207-754-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health