Provider Demographics
NPI:1033784665
Name:GLANZ, MAXWELL TODD
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:TODD
Last Name:GLANZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PINON AVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1938
Mailing Address - Country:US
Mailing Address - Phone:510-381-8110
Mailing Address - Fax:
Practice Address - Street 1:865 MARINA BAY PKWY STE 37
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6426
Practice Address - Country:US
Practice Address - Phone:510-422-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst