Provider Demographics
NPI:1801911805
Name:GLAZER, LESLIE (PHD LMHC)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:GLAZER
Suffix:
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:WEST PAWLET
Mailing Address - State:VT
Mailing Address - Zip Code:05775-0198
Mailing Address - Country:US
Mailing Address - Phone:802-447-8554
Mailing Address - Fax:
Practice Address - Street 1:120 ELM ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2865
Practice Address - Country:US
Practice Address - Phone:413-664-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000928103TC0700X
VT047-0000653103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist