Provider Demographics
NPI:1518382803
Name:GLAZER, DENA (LMSW)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:GLAZER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 ROUTE 209
Mailing Address - Street 2:PENNSYLVANIA AUTISM ACTION CENTER
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7754
Mailing Address - Country:US
Mailing Address - Phone:570-992-6720
Mailing Address - Fax:
Practice Address - Street 1:2071 ROUTE 209
Practice Address - Street 2:PENNSYLVANIA AUTISM ACTION CENTER
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7754
Practice Address - Country:US
Practice Address - Phone:570-992-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker