Provider Demographics
NPI:1962577015
Name:GLYNN, SANDY G (LICSW)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:G
Last Name:GLYNN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:S
Other - Last Name:GARTENBAUM-GLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9725
Mailing Address - Country:US
Mailing Address - Phone:413-387-5129
Mailing Address - Fax:
Practice Address - Street 1:90 CONZ ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3881
Practice Address - Country:US
Practice Address - Phone:413-387-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1150191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical