Healthcare Provider Details

I. General information

NPI: 1336326982
Provider Name (Legal Business Name): DAVID BRUCE GLASSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MONUMENT ROAD BELMONT CENTER
PHILADELPHIA PA
19131
US

IV. Provider business mailing address

4200 MONUMENT ROAD BELMONT CENTER
PHILADELPHIA PA
19131
US

V. Phone/Fax

Practice location:
  • Phone: 215-581-9142
  • Fax: 215-581-3827
Mailing address:
  • Phone: 215-581-9142
  • Fax: 215-581-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS008748L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: