Healthcare Provider Details

I. General information

NPI: 1487084042
Provider Name (Legal Business Name): LESLIE A GLASSMAN PSYD, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107E SHAWNEE SQURE DR. SE
SHAWNEE ON DELAWARE PA
18356
US

IV. Provider business mailing address

69 ARROWWOOD DR UNIT A
EAST STROUDSBURG PA
18302-9640
US

V. Phone/Fax

Practice location:
  • Phone: 570-369-4991
  • Fax:
Mailing address:
  • Phone: 570-234-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH000497
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: