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General NPI Number Information
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NPI Number | 1255847968
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Entity Type | Individual
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Provider Name | BRIDGET KATHLEEN GLASS PH.D., LMHC, ACS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 8305 WOODSMUIR DR
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33412-1631
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Country | US
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Telephone | 561-316-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 10130 NORTHLAKE BLVD STE 214
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-1105
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Country | US
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Telephone | 772-204-4208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17923
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH17923
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License Number State | FL
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