MEDICARE: DR. SUSAN GLASKIN PSY 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
1	103T00000X	Psychologist	PS004177L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0438400000	OTHER	PA	AMERIHEALTH

General Provider Information

NPI Number	:	1801882717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN GLASKIN PSY D

Provider Business Mailing Address
First Line	:	1240 S BROAD ST
Second Line	:	STE 220
City	:	LANSDALE
State	:	PA
Zip	:	19446-5395
Country	:	US
Telephone Number	:	215-699-3901
Fax Number	:	215-699-3909

Provider Business Practice Location Address
First Line	:	1240 S BROAD ST
Second Line	:	STE 220
City	:	LANSDALE
State	:	PA
Zip	:	19446-5395
Country	:	US
Telephone Number	:	215-699-3901
Fax Number	:	215-699-3909

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	07/08/2007

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