Provider Demographics
NPI:1548304330
Name:GLAZIER, STEVEN B (MA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:B
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1257
Mailing Address - Country:US
Mailing Address - Phone:215-782-3160
Mailing Address - Fax:215-782-3161
Practice Address - Street 1:201 N PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1257
Practice Address - Country:US
Practice Address - Phone:215-782-3160
Practice Address - Fax:215-782-3161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005789L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015336200004Medicaid