Provider Demographics
NPI:1962923029
Name:DAVIS, GLENN SAMUEL (LMHC)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:SAMUEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BIRCHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1606
Mailing Address - Country:US
Mailing Address - Phone:978-270-0049
Mailing Address - Fax:
Practice Address - Street 1:8 BIRCHWOOD TER
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1606
Practice Address - Country:US
Practice Address - Phone:978-270-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health