=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376771253
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOCORRA GLENNON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2009
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 46 SEAVIEW DR
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-224-7910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2004
-----------------------------------------------------
City | MANOMET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02345-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------