Provider Demographics
NPI:1073812921
Name:GLASSMAN, MARILYN (MA,MFT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:GLASSMAN
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST STE 118
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4314
Mailing Address - Country:US
Mailing Address - Phone:818-292-4226
Mailing Address - Fax:818-874-3066
Practice Address - Street 1:30423 CANWOOD ST STE 118
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4314
Practice Address - Country:US
Practice Address - Phone:818-292-4226
Practice Address - Fax:818-874-3066
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist