Gerald A. Glass, LLBSW, CADC-DP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6802090961 Issued in MI

Practice address

120 S Main St Ste C
Milford, MI 48381-1975

Phone

(248) 529-6383

Fax

(866) 250-6455

NPI assigned

Sep 8, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mr. Jerry Glass Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1275147126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 S MAIN ST STE C",
            "city": "MILFORD",
            "state": "MI",
            "postal_code": "483811975",
            "telephone_number": "248-529-6383",
            "fax_number": "866-250-6455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S MAIN ST STE C",
            "city": "MILFORD",
            "state": "MI",
            "postal_code": "483811975",
            "telephone_number": "248-529-6383",
            "fax_number": "866-250-6455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50331 Lincoln Dr",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MI",
            "postal_code": "481702363",
            "country_code": "US",
            "telephone_number": "313-782-2699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLASS",
        "first_name": "GERALD",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "LLBSW, CADC-DP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6802090961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERRY",
            "last_name": "GLASS",
            "prefix": "MR.",
            "credential": "LLBSW, CADC-DP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Social Worker in Milford, MI
• Providers in Milford, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.