Provider Demographics
NPI:1396704979
Name:GLENDON, THOMAS EVERS (LCSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EVERS
Last Name:GLENDON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CONGRESS ST STE 601F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3343
Mailing Address - Country:US
Mailing Address - Phone:207-831-6260
Mailing Address - Fax:207-681-5385
Practice Address - Street 1:411 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3505
Practice Address - Country:US
Practice Address - Phone:207-831-6260
Practice Address - Fax:207-681-5385
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC69731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
047825OtherANTHEM PROVIDER ID
047825OtherANTHEM PROVIDER ID