MEDICARE: ALLISON MERYL GLASSCOCK PSY.D.

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	103TC0700X	Clinical Psychologist	019758	NY
2	103T00000X	Psychologist	019758	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033532445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MERYL GLASSCOCK PSY.D.

Provider Business Mailing Address
First Line	:	625 E 11TH ST APT A3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-9751
Country	:	US
Telephone Number	:	917-420-0267
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 E 11TH ST APT A3
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-9751
Country	:	US
Telephone Number	:	917-420-0267
Fax Number	:

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	07/31/2024

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