MEDICARE: ROBERT H. GLASS, PH.D. PSYCHOLOGICAL CORPORATION

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	103TA0700X	Adult Development & Aging Psychologist	PSY13687	CA
2	103TC0700X	Clinical Psychologist	PSY13687	CA
3	103TC2200X	Clinical Child & Adolescent Psychologist	PSY13687	CA

General Provider Information

NPI Number	:	1578766184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT H. GLASS, PH.D. PSYCHOLOGICAL CORPORATION

Provider Business Mailing Address
First Line	:	462 S MARENGO AVE
Second Line	:	SUITE # 1
City	:	PASADENA
State	:	CA
Zip	:	91101-3129
Country	:	US
Telephone Number	:	626-449-9548
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 S MARENGO AVE
Second Line	:	SUITE # 1
City	:	PASADENA
State	:	CA
Zip	:	91101-3129
Country	:	US
Telephone Number	:	626-449-9548
Fax Number	:

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. ROBERT GLASS
Credential	:	PH.D.
Telephone Number	:	626-449-9548

Provider Enumeration Date	:	06/10/2007
Last Update Date	:	09/11/2025

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