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NPI Code Detail

MEDICARE: RUTH BONNIE GLASER PH.D.

MEDICARE: RUTH BONNIE GLASER PH.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
1101YP2500XProfessional CounselorPSY 5242CA
2102L00000XPsychoanalystPSY 5242CA

General Provider Information

NPI Number : 1073887824
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH BONNIE GLASER PH.D.
Provider Business Mailing Address
First Line : 3036 REGENT ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2551
Country : US
Telephone Number : 510-333-2367
Fax Number :
Provider Business Practice Location Address
First Line : 3036 REGENT ST
Second Line :
City : BERKELEY
State : CA
Zip : 94705-2551
Country : US
Telephone Number : 510-333-2367
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2012
Last Update Date : 02/25/2012

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