Provider Demographics
NPI:1548392723
Name:GLASS, KIMBERLY LYNNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:GLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2224
Mailing Address - Country:US
Mailing Address - Phone:202-841-8149
Mailing Address - Fax:202-544-1807
Practice Address - Street 1:8720 GEORGIA AVE
Practice Address - Street 2:STE. 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3638
Practice Address - Country:US
Practice Address - Phone:301-565-0534
Practice Address - Fax:301-565-2217
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04238103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist