MEDICARE: DR. BRIDGET KATHLEEN GLASS PH.D., LMHC, ACS

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	101YM0800X	Mental Health Counselor	17923	FL
2	101YM0800X	Mental Health Counselor	MH17923	FL

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	:	1255847968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIDGET KATHLEEN GLASS PH.D., LMHC, ACS

Provider Business Mailing Address
First Line	:	10130 NORTHLAKE BLVD STE 214
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-1105
Country	:	US
Telephone Number	:	772-204-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	8305 WOODSMUIR DR
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33412-1631
Country	:	US
Telephone Number	:	561-316-8630
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	09/05/2023

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