Provider Demographics
NPI:1902142821
Name:GLICKMAN, ROBYN ELANA (PHD,LMFT,LLPCAADC)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:ELANA
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:PHD,LMFT,LLPCAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21395 GLENMORRA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6016
Mailing Address - Country:US
Mailing Address - Phone:248-943-9298
Mailing Address - Fax:
Practice Address - Street 1:5665 W MAPLE RD STE A
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3741
Practice Address - Country:US
Practice Address - Phone:248-943-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI6301014228103T00000X
MI6361006355103TC0700X
MI4101007304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical