Individual
KASSONDRA GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1331 PARK AVE SW, ALBUQUERQUE, NM 87102-4565
(917) 819-2883
Mailing address
PO BOX 11, ALBUQUERQUE, NM 87103-0011
(917) 819-2883
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
109505
NY
104100000X
Social Worker
M-11417
NM
1041C0700X
Clinical Social Worker
CSW.09928813
CO
1041C0700X
Clinical Social Worker
Primary
SWB-2022-1045
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92635849
—
NM
Enumeration date
10/26/2020
Last updated
06/02/2023
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