Organization
KASSONDRA GLENN LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KASSONDRA GLENN LCSW (OWNER)
(917) 819-2883
Entity
Organization
Contact information
Practice address
1331 PARK AVE SW, ALBUQUERQUE, NM 87102-4565
(917) 819-2883
Mailing address
PO BOX 11, ALBUQUERQUE, NM 87103-0011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78180244
—
NM
Enumeration date
01/30/2023
Last updated
06/02/2023
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