MEDICARE: MR. ERNEST GLAZER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW014059	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW014059	OTHER	PA	LICENSED CLINICAL SOCIAL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497838403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERNEST GLAZER LCSW

Provider Business Mailing Address
First Line	:	1224 DUNCAN DR
Second Line	:
City	:	DRESHER
State	:	PA
Zip	:	19025-1614
Country	:	US
Telephone Number	:	215-659-9199
Fax Number	:	215-830-8432

Provider Business Practice Location Address
First Line	:	1120 EASTON RD
Second Line	:	THE CENTER FOR FAMILY DEVELOPMENT -SUITE ONE
City	:	WILLOW GROVE
State	:	PA
Zip	:	19090-1922
Country	:	US
Telephone Number	:	215-830-8430
Fax Number	:	215-830-8432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/09/2007

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