Healthcare Provider Details

I. General information

NPI: 1710019682
Provider Name (Legal Business Name): ANGELA E GLISSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA LOPES

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COVE ST
FALL RIVER MA
02720-1357
US

IV. Provider business mailing address

90 ROWLEY ST
SWANSEA MA
02777-4943
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-0041
  • Fax: 508-324-9002
Mailing address:
  • Phone: 781-437-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6408
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier685661
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS
# 2
IdentifierM18708
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS
# 3
Identifier1312677
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: