Individual
GLENN WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 SOUTHERN AVE, BOSTON, MA 02124-2012
(617) 291-9667
Mailing address
12 SOUTHERN AVE, BOSTON, MA 02124-2012
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174975452
MENTAL HEALTH INSTITUTE
MA
Enumeration date
07/14/2021
Last updated
07/14/2021
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