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General NPI Number Information
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NPI Number | 1417224791
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Entity Type | Organization
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Legal Business Name | ROBERT S. GLAZER, PH.D., P.A.
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 19802 OLD BELLAMY RD
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City | ALACHUA
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State | FL
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Zip | 32615-3867
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Country | US
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Telephone | 386-462-5155
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Fax | 386-462-1952
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Provider Business Mailing Address
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Address Line | 19802 OLD BELLAMY RD
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City | ALACHUA
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State | FL
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Zip | 32615-3867
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Country | US
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Telephone | 386-462-5155
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Fax | 386-462-1952
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT GLAZER
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Credential | PH.D.
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Telephone | 386-462-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 4152
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License Number State | FL
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