Provider Demographics
NPI:1578843363
Name:RICHARDSON, GLENN (CASEMANAGER)
Entity type:Individual
Prefix:MR
First Name:GLENN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:CASEMANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 JORALEMON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4306
Mailing Address - Country:US
Mailing Address - Phone:718-722-6000
Mailing Address - Fax:
Practice Address - Street 1:249 CLASSON AVE
Practice Address - Street 2:MERCY GARDENS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1440
Practice Address - Country:US
Practice Address - Phone:718-399-8141
Practice Address - Fax:718-399-3208
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator