MEDICARE: MR. JONATHAN GLICK L.S.W

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	1041C0700X	Clinical Social Worker	44SL05935700	NJ

General Provider Information

NPI Number	:	1437503984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN GLICK L.S.W

Provider Business Mailing Address
First Line	:	105 SOUTH ST APT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4723
Country	:	US
Telephone Number	:	201-888-2578
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 SOUTH ST APT 3
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-4723
Country	:	US
Telephone Number	:	201-888-2578
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/29/2024

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