Provider Demographics
NPI:1548538945
Name:GLASER FORNESIC GROUP
Entity type:Organization
Organization Name:GLASER FORNESIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-382-9920
Mailing Address - Street 1:16530 VENTURA BLVD
Mailing Address - Street 2:601
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4554
Mailing Address - Country:US
Mailing Address - Phone:818-382-9920
Mailing Address - Fax:818-385-1155
Practice Address - Street 1:16530 VENTURA BLVD
Practice Address - Street 2:601
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4554
Practice Address - Country:US
Practice Address - Phone:818-382-9920
Practice Address - Fax:818-385-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40041103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty