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: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 1630
FOREST HILLS NY
11375-7251
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax: 845-622-3636
Mailing address:
  • Phone: 845-279-5908
  • Fax: 845-622-5055

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: