Healthcare Provider Details

I. General information

NPI: 1033509674
Provider Name (Legal Business Name): JONATHAN HARRY LIGHTER GLICKMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WASHINGTON AVE APT 6S
BROOKLYN NY
11225-1041
US

IV. Provider business mailing address

710 STATION WAY
HUNTINGTON STATION NY
11746-1937
US

V. Phone/Fax

Practice location:
  • Phone: 516-567-5036
  • Fax:
Mailing address:
  • Phone: 516-567-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number024891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: