Provider Demographics
NPI:1366644858
Name:ARSENAULT, GLENN
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:ARSENAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEWTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:253 SUMMER ST
Practice Address - Street 2:5TH FLR - CMA
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1114
Practice Address - Country:US
Practice Address - Phone:888-897-8947
Practice Address - Fax:617-772-5519
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor