Provider Demographics
NPI:1548485683
Name:GLOGOWSKI, JAMES EDWARD (CSW, PHD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:GLOGOWSKI
Suffix:
Gender:M
Credentials:CSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5967
Mailing Address - Country:US
Mailing Address - Phone:716-626-1234
Mailing Address - Fax:
Practice Address - Street 1:6636 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5967
Practice Address - Country:US
Practice Address - Phone:716-626-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0192991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11862BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #