Provider Demographics
NPI:1063672939
Name:GLASSIC, EDWARD S (MA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:GLASSIC
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:LAURELDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19605-2220
Mailing Address - Country:US
Mailing Address - Phone:610-929-2138
Mailing Address - Fax:
Practice Address - Street 1:3314 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605-2220
Practice Address - Country:US
Practice Address - Phone:610-929-2138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health