Provider Demographics
NPI:1043757040
Name:GLIDEWELL, SORAYA (MHC)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:SORAYA
Other - Middle Name:ZARINA
Other - Last Name:DIAZ VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 LISK AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1798
Mailing Address - Country:US
Mailing Address - Phone:718-307-8830
Mailing Address - Fax:
Practice Address - Street 1:1 HOYT ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5809
Practice Address - Country:US
Practice Address - Phone:718-802-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health