MEDICARE: BONNIE GLICKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1023387123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE GLICKMAN

Provider Business Mailing Address
First Line	:	683 COMMONWEALTH AVE
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1102
Country	:	US
Telephone Number	:	401-862-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	683 COMMONWEALTH AVE
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1102
Country	:	US
Telephone Number	:	401-862-9330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2011
Last Update Date	:	12/19/2011

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Directions to “ BONNIE GLICKMAN ” Practice Location

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