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General NPI Number Information
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NPI Number | 1801911805
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Entity Type | Individual
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Provider Name | LESLIE GLAZER PH.D. LMHC
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 120 ELM ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2865
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Country | US
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Telephone | 413-664-4541
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 198
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City | WEST PAWLET
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State | VT
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Zip | 05775-0198
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Country | US
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Telephone | 802-447-8554
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 048-0000928
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License Number State | VT
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