Healthcare Provider Details

I. General information

NPI: 1487766770
Provider Name (Legal Business Name): GAIL M GLICK LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 THOMAS JOHNSON DR STE 204
FREDERICK MD
21702-4404
US

IV. Provider business mailing address

172 THOMAS JOHNSON DR STE 204
FREDERICK MD
21702-4404
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-8343
  • Fax: 301-695-0746
Mailing address:
  • Phone: 301-663-8343
  • Fax: 301-695-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number03205
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: