Individual provider Active NPI

Alison Lynn Glanville, PSYD

  • Clinical Psychologist
  • Bangor, ME
National Provider Identifier
1104080381
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS1272 Issued in ME
Practice address
29 Franklin St
Bangor, ME 04401-4909
Phone
(207) 942-3816
Fax
(207) 561-4725
NPI assigned
Jul 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS1272 ME Primary

Addresses

Primary practice location

29 Franklin St
Bangor, ME 04401-4909

Mailing address

29 Franklin St
Bangor, ME 04401-4909
Phone (207) 942-3816

Other identifiers 1

IdentifierTypeStateIssuer
432786799MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PS1272MEMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Occupational Exchange, Inc PastSince Aug 13, 2004 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1104080381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLANVILLE",
        "first_name": "ALISON",
        "middle_name": "LYNN",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-16",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS1272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432786799",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.