MEDICARE: STEPHEN GLIDDEN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	106775

General Provider Information

NPI Number	:	1407998750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GLIDDEN LICSW

Provider Business Mailing Address
First Line	:	48 JUNIPER RD
Second Line	:
City	:	MARSHFIELD
State	:	MA
Zip	:	02050-4416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 INDUSTRIAL PARK RD # A
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4868
Country	:	US
Telephone Number	:	508-830-1444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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