| NPI | 1326348459 |
|---|---|
| Former Name | LAUREN ROSE GLENNON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003383) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103T00000X Psychologist (Licence: CT 003383) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2020-02-12 |