Healthcare Provider Details

I. General information

NPI: 1689776676
Provider Name (Legal Business Name): ELLEN SARASOHN GLAZER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FARLOW RD
NEWTON MA
02458
US

IV. Provider business mailing address

55 FARLOW RD
NEWTON MA
02458
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-3468
  • Fax:
Mailing address:
  • Phone: 617-332-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101150SOCIAL WORK
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier02421800
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLEN
# 2
Identifier709953
Identifier TypeOTHER
Identifier State
Identifier IssuerTUFTS
# 3
IdentifierP01400
Identifier TypeOTHER
Identifier State
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: