MEDICARE: MS. PAMELA M. GLASS 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	105611	MA

General Provider Information

NPI Number	:	1902995954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA M. GLASS LICSW

Provider Business Mailing Address
First Line	:	124 BIRD ST
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02492-4358
Country	:	US
Telephone Number	:	781-449-7940
Fax Number	:	781-449-8045

Provider Business Practice Location Address
First Line	:	36 WESTON AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-1833
Country	:	US
Telephone Number	:	617-786-0137
Fax Number	:	617-479-4798

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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