MEDICARE: NAHTASCHA GLEABES

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	103TM1800X	Intellectual & Developmental Disabilities Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1730731183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAHTASCHA GLEABES

Provider Business Mailing Address
First Line	:	396 HIGHLAND AVE
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-3223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	396 HIGHLAND AVE
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-3223
Country	:	US
Telephone Number	:	551-444-8110
Fax Number	:

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

Provider Enumeration Date	:	07/15/2019
Last Update Date	:	07/15/2019

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Directions to “ NAHTASCHA GLEABES ” Practice Location

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