Provider Demographics
NPI:1073666947
Name:GLICKSTEIN, RICHARD (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GLICKSTEIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 RIVERBANK
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1312
Mailing Address - Country:US
Mailing Address - Phone:856-983-3900
Mailing Address - Fax:
Practice Address - Street 1:114 RIVERBANK
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-1312
Practice Address - Country:US
Practice Address - Phone:856-983-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional