Healthcare Provider Details

I. General information

NPI: 1710326368
Provider Name (Legal Business Name): LINDA J GLASSER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SHERMAN WAY 165
VAN NUYS CA
91406-3875
US

IV. Provider business mailing address

1701 MALCOLM AVE 5
LOS ANGELES CA
90024-6845
US

V. Phone/Fax

Practice location:
  • Phone: 818-386-1094
  • Fax: 818-386-1182
Mailing address:
  • Phone: 818-386-1094
  • Fax: 818-386-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: