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General NPI Number Information
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NPI Number | 1972859338
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Entity Type | Individual
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Provider Name | MATTHEW HOWARD GLASS LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 17861 OAKMONT RIDGE CIR
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City | FORT MYERS
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State | FL
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Zip | 33967-7202
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Country | US
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Telephone | 239-839-5904
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Fax | 239-362-3298
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Provider Business Mailing Address
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Address Line | 9180 ESTERO PARK COMMONS BLVD STE 2
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City | ESTERO
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State | FL
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Zip | 33928-3218
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Country | US
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Telephone | 239-839-5904
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Fax | 239-495-7772
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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 | SW 10707
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License Number State | FL
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