Healthcare Provider Details

I. General information

NPI: 1841731684
Provider Name (Legal Business Name): MICHAEL SAM GLYNN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 S BROAD ST
NEW ORLEANS LA
70125-1953
US

IV. Provider business mailing address

2700 S BROAD ST
NEW ORLEANS LA
70125-1953
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: