Provider Demographics
NPI:1710725379
Name:GLENNON, VICTORIA (BCBA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GLENNON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 VAUTRINOT AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-1119
Mailing Address - Country:US
Mailing Address - Phone:781-738-7402
Mailing Address - Fax:
Practice Address - Street 1:11 VAUTRINOT AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-1119
Practice Address - Country:US
Practice Address - Phone:804-215-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst