Provider Demographics
NPI:1144645631
Name:GLICKMAN, IAN (PHD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 LARKINS BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4544
Mailing Address - Country:US
Mailing Address - Phone:610-458-9135
Mailing Address - Fax:
Practice Address - Street 1:519 LARKINS BRIDGE DR
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-4544
Practice Address - Country:US
Practice Address - Phone:610-458-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling