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General NPI Number Information
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NPI Number | 1386740306
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Entity Type | Individual
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Provider Name | MICHELLE GLIDDEN LMHC, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 VICTORY RD
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City | QUINCY
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State | MA
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Zip | 02171-3139
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Country | US
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Telephone | 617-774-1059
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Fax |
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Provider Business Mailing Address
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Address Line | 48 JUNIPER RD
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City | MARSHFIELD
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State | MA
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Zip | 02050-4416
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Country | US
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Telephone | 781-834-3626
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 633
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License Number State | MA
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