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General NPI Number Information
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NPI Number | 1104749050
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Entity Type | Individual
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Provider Name | JULIA FAITH GLENN
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Gender | Female
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 900 MAIN STREET
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City | WATERTOWN
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State | CT
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Zip | 06795
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Country | US
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Telephone | 203-208-9844
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Fax |
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Provider Business Mailing Address
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Address Line | 16 EMERALD RIDGE CT
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City | SHELTON
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State | CT
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Zip | 06484-2178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-26-2827414
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License Number State | CT
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