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General NPI Number Information
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NPI Number | 1457709529
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Entity Type | Organization
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Legal Business Name | PHARA GLADDEN,LCSW,PLLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 978 ROUTE 45 SUITE 104
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City | POMONA
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State | NY
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Zip | 10970-3521
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Country | US
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Telephone | 845-596-8006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20
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City | BLAUVELT
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State | NY
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Zip | 10913-0020
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Country | US
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Telephone | 845-596-8006
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. PHARA GLADDEN
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Credential | LCSW-R
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Telephone | 845-596-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075198
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License Number State | NY
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