MEDICARE: GLENN MARLA SMULYAN ATR-BC, LCAT

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	221700000X	Art Therapist	002049	NY

General Provider Information

NPI Number	:	1548823644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN MARLA SMULYAN ATR-BC, LCAT

Provider Business Mailing Address
First Line	:	1010 DORCHESTER RD APT 4C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5336
Country	:	US
Telephone Number	:	917-399-0310
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 BERKELEY PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3802
Country	:	US
Telephone Number	:	917-727-4674
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/15/2019

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