Doctor Name: | MR. GLENN WARREN FROST |
NPI Number: | 1053491555 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW-R, ACSW |
License Number: | R049406-1 |
Business Practice Address: | 884 Brighton Rd Tonawanda, NY - 141508169 |
Business Phone Number: | 7168369460 |
Business Fax Number: | 7168369462 |
Mailing Address: | 254 Peppertree Dr, AMHERST |
State: | NY |
Postal Code: | 142282949 |
Phone Number: | 7165640296 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | R049406-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |