Healthcare Provider Details

I. General information

NPI: 1932240843
Provider Name (Legal Business Name): GLIMMERGLASS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 BAY AVE SUITE 2
PT. PLEASANT BEACH NJ
08742
US

IV. Provider business mailing address

1648 BAY AVE SUITE 2
PT. PLEASANT BEACH NJ
08742
US

V. Phone/Fax

Practice location:
  • Phone: 732-899-8288
  • Fax: 732-899-6962
Mailing address:
  • Phone: 732-899-8288
  • Fax: 732-899-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00424300
License Number StateNJ

VIII. Authorized Official

Name: DR. JOANNE MARIE MCNAMARA
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 732-899-8288