MEDICARE: HARRIET B GLASS MA LMFT

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	106H00000X	Marriage & Family Therapist	MFT40	HI

General Provider Information

NPI Number	:	1659355071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET B GLASS MA LMFT

Provider Business Mailing Address
First Line	:	2443 PACIFIC HEIGHTS RD
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813
Country	:	US
Telephone Number	:	808-521-9720
Fax Number	:	808-537-1684

Provider Business Practice Location Address
First Line	:	2443 PACIFIC HEIGHTS RD
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813
Country	:	US
Telephone Number	:	808-521-9720
Fax Number	:	808-537-1684

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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