Healthcare Provider Details

I. General information

NPI: 1760599716
Provider Name (Legal Business Name): KATHLEEN SUSAN GLOW-MORGAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ALBANY ST
CAZENOVIA NY
13035-1201
US

IV. Provider business mailing address

2070 MAIN ST
NEW WOODSTOCK NY
13122-9757
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-8085
  • Fax:
Mailing address:
  • Phone: 315-662-7726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR056230-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: