MEDICARE: MRS. FRANCES GLICKER MENTAL HEATH COUNCEL

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	101YM0800X	Mental Health Counselor	064428-1	NY
2	101YM0800X	Mental Health Counselor	004134-1	NY

General Provider Information

NPI Number	:	1629320346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FRANCES GLICKER MENTAL HEATH COUNCEL

Provider Business Mailing Address
First Line	:	10440 QUEENS BLVD
Second Line	:	20C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3637
Country	:	US
Telephone Number	:	718-789-8392
Fax Number	:	718-230-1901

Provider Business Practice Location Address
First Line	:	10440 QUEENS BLVD
Second Line	:	20C
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3637
Country	:	US
Telephone Number	:	718-789-8392
Fax Number	:	718-230-1901

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

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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