Basic Information
| Provider Information | |||||||||
| NPI: | 1235265489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOVER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LINDA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4332 KISSENA BLVD | ||||||||
| Address2: | APT 16M | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183530653 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14015B SANFORD AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113552557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183588288 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 065988 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.