Provider Demographics
NPI:1023178829
Name:BYHOUWER, GLENDA (LICSW, LCDP, CDCS)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:BYHOUWER
Suffix:
Gender:F
Credentials:LICSW, LCDP, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 OLD RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1161
Mailing Address - Country:US
Mailing Address - Phone:401-333-2002
Mailing Address - Fax:
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1158
Practice Address - Country:US
Practice Address - Phone:401-333-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00137101YA0400X
RIISW00751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30453-9OtherBLUE CROSS
RI406358OtherBLUE CHIP