Provider Demographics
NPI:1699438374
Name:GOZIGIAN WOOD, GLYNIS (LICSW)
Entity type:Individual
Prefix:
First Name:GLYNIS
Middle Name:
Last Name:GOZIGIAN WOOD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-1128
Mailing Address - Country:US
Mailing Address - Phone:617-319-6641
Mailing Address - Fax:
Practice Address - Street 1:144 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-1128
Practice Address - Country:US
Practice Address - Phone:617-319-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1237381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical