Healthcare Provider Details

I. General information

NPI: 1356417547
Provider Name (Legal Business Name): LAURENCE ADAM GLASSER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD 110
RESEDA CA
91335-6308
US

IV. Provider business mailing address

19231 VICTORY BLVD 110
RESEDA CA
91335-6308
US

V. Phone/Fax

Practice location:
  • Phone: 818-708-4500
  • Fax: 818-654-1956
Mailing address:
  • Phone: 818-708-4500
  • Fax: 818-654-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA71383
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: