Healthcare Provider Details

I. General information

NPI: 1407860075
Provider Name (Legal Business Name): STEPHEN G. GLASS ED.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 OLD FORGE XING
DEVON PA
19333-1121
US

IV. Provider business mailing address

176 OLD FORGE XING
DEVON PA
19333-1121
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-1138
  • Fax:
Mailing address:
  • Phone: 610-688-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS003422L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS003422L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: