MEDICARE: MS. ALEXIS S GLENNON LCSW

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	083536	NY

General Provider Information

NPI Number	:	1780081737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXIS S GLENNON LCSW

Provider Business Mailing Address
First Line	:	2332 STATE ROUTE 90
Second Line	:
City	:	AURORA
State	:	NY
Zip	:	13026-8680
Country	:	US
Telephone Number	:	315-730-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 WILLIAM ST STE 7
Second Line	:
City	:	AUBURN
State	:	NY
Zip	:	13021-3730
Country	:	US
Telephone Number	:	315-730-7561
Fax Number	:

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

Provider Enumeration Date	:	11/19/2014
Last Update Date	:	06/11/2019

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