MEDICARE: MR. GEORGE P GLASER M.S.W.

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	00319 LCSW	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	54112070	OTHER	TX	BLUE CROSS BLUE SHIELD OF TEXAS

General Provider Information

NPI Number	:	1891797163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE P GLASER M.S.W.

Provider Business Mailing Address
First Line	:	11005 SHADY HOLLOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1819
Country	:	US
Telephone Number	:	512-371-9418
Fax Number	:	512-637-8889

Provider Business Practice Location Address
First Line	:	11005 SHADY HOLLOW DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1819
Country	:	US
Telephone Number	:	512-371-9418
Fax Number	:	512-637-8889

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/24/2024

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