Healthcare Provider Details

I. General information

NPI: 1932034154
Provider Name (Legal Business Name): JOSHUA ISAAC GLIDDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HANCOCK ST
QUINCY MA
02169-4339
US

IV. Provider business mailing address

65 WELLES AVE
DORCHESTER MA
02124-3637
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-0600
  • Fax:
Mailing address:
  • Phone: 978-758-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: