Organization Name: | ROBERT S. GLAZER, PH.D., P.A. |
NPI Number: | 1417224791 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT GLAZER (OWNER) |
Mailing Address: | 19802 Old Bellamy Rd Alachua |
State: | FL US |
Postal Code: | 326153867 |
Phone Number: | 3864625155 |
Fax Number: | 3864621952 |
NPI Enumeration Date: | 11/30/2011 |
NPI Last Update Date: | 11/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY 4152 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |