Skip Navigation Link. Please press insert + down arrow if jaws does not start reading the content.

Provider Information for 1912135666


The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

GLEN T PROSPERE


Sex: Male

NPI: 1912135666
Last Updated: 2009-07-06
Certification Date:

Details

NameValue
NPI1912135666
Enumeration Date2009-07-01
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 43 PIERCE STREET
HYDE PARK, MA 02136
United States

Phone: 617-364-9464 | Fax:
 
Primary Practice Address 1601 WASHINGTON STREET
BOSTON, MA 02118-1951
United States

Phone: 617-425-2000 | Fax:617-424-8725
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthMA6911