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General NPI Number Information
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NPI Number | 1386042679
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Entity Type | Individual
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Provider Name | JANN GLIDER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 6811 QUINCY ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2663
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Country | US
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Telephone | 215-514-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 514 E LANCASTER AVE APT C1
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City | WYNNEWOOD
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State | PA
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Zip | 19096-2348
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Country | US
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Telephone | 215-514-2130
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS 004336-L
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License Number State | PA
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