Provider Demographics
NPI:1174094171
Name:GLOVER, CRYSTAL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9332
Mailing Address - Country:US
Mailing Address - Phone:812-773-8321
Mailing Address - Fax:812-993-1846
Practice Address - Street 1:5155 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9332
Practice Address - Country:US
Practice Address - Phone:812-773-8321
Practice Address - Fax:812-993-1846
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008346A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14375674OtherCAQH