Healthcare Provider Details

I. General information

NPI: 1053493445
Provider Name (Legal Business Name): ARIEL GLICK PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST MS 232
BELMONT MA
02478-1064
US

IV. Provider business mailing address

115 MILL ST MS 232
BELMONT MA
02478-1064
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-4520
  • Fax:
Mailing address:
  • Phone: 617-855-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number9143
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: