Provider Demographics
NPI:1396136503
Name:DR MARSHAUN GLOVER LLC
Entity type:Organization
Organization Name:DR MARSHAUN GLOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHAUN
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-869-0464
Mailing Address - Street 1:112 WATER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4206
Mailing Address - Country:US
Mailing Address - Phone:229-869-0464
Mailing Address - Fax:
Practice Address - Street 1:112 WATER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4206
Practice Address - Country:US
Practice Address - Phone:229-869-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty