Healthcare Provider Details

I. General information

NPI: 1598629396
Provider Name (Legal Business Name): GLENN SCOTT LIVINGSTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N OCEAN BLVD APT 412
POMPANO BEACH FL
33062-4603
US

IV. Provider business mailing address

710 N OCEAN BLVD APT 412
POMPANO BEACH FL
33062-4603
US

V. Phone/Fax

Practice location:
  • Phone: 603-490-3844
  • Fax: 516-706-0475
Mailing address:
  • Phone: 603-490-3844
  • Fax: 516-706-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: