Provider Demographics
NPI:1548278120
Name:HOWARD J GLIDDEN PH D PSYCHOLOGIST INC
Entity type:Organization
Organization Name:HOWARD J GLIDDEN PH D PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GLIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-431-8741
Mailing Address - Street 1:1660 E HERNDON AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3359
Mailing Address - Country:US
Mailing Address - Phone:559-431-8500
Mailing Address - Fax:559-431-8520
Practice Address - Street 1:1660 E HERNDON AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3359
Practice Address - Country:US
Practice Address - Phone:559-431-8500
Practice Address - Fax:559-431-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL141450Medicare ID - Type Unspecified