Healthcare Provider Details

I. General information

NPI: 1881604361
Provider Name (Legal Business Name): GARY JAMES GLACKEN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 HIGHLAND DR
PITTSBURGH PA
15206-1206
US

IV. Provider business mailing address

3109 WESTCHESTER DR
PITTSBURGH PA
15238-1139
US

V. Phone/Fax

Practice location:
  • Phone: 412-365-5792
  • Fax: 412-365-5778
Mailing address:
  • Phone: 412-767-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW001892E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: