Provider Demographics
NPI:1366775587
Name:GLENNON, KEVIN CHARLES (MSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHARLES
Last Name:GLENNON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WOODLAND ST
Mailing Address - Street 2:UNIT 2G
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4335
Mailing Address - Country:US
Mailing Address - Phone:860-522-9221
Mailing Address - Fax:
Practice Address - Street 1:31 WOODLAND ST
Practice Address - Street 2:UNIT 2G
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4335
Practice Address - Country:US
Practice Address - Phone:860-522-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health