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General NPI Number Information
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NPI Number | 1245670884
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Entity Type | Individual
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Provider Name | GLEN CALVERT LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 6243 W INTERSTATE 10 STE 1050
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City | SAN ANTONIO
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State | TX
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Zip | 78201-2086
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Country | US
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Telephone | 210-293-0883
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Fax | 210-293-0885
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Provider Business Mailing Address
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Address Line | 6243 W INTERSTATE 10 STE 1050
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City | SAN ANTONIO
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State | TX
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Zip | 78201-2086
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Country | US
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Telephone | 210-293-0883
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Fax | 210-293-0885
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 50335
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License Number State | TX
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