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General NPI Number Information
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NPI Number | 1548538945
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Entity Type | Organization
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Legal Business Name | GLASER FORNESIC GROUP
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 16530 VENTURA BLVD 601
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City | ENCINO
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State | CA
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Zip | 91436-4554
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Country | US
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Telephone | 818-382-9920
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Fax | 818-385-1155
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Provider Business Mailing Address
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Address Line | 16530 VENTURA BLVD 601
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City | ENCINO
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State | CA
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Zip | 91436-4554
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Country | US
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Telephone | 818-382-9920
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Fax | 818-385-1155
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GARY GOLTER
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Credential |
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Telephone | 818-382-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | G40041
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License Number State | CA
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