Provider Demographics
NPI:1114471638
Name:GLICKMAN, ALLISON SUE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:SUE
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GIBBS XING
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6466
Mailing Address - Country:US
Mailing Address - Phone:860-608-6096
Mailing Address - Fax:
Practice Address - Street 1:50 GIBBS XING
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-6466
Practice Address - Country:US
Practice Address - Phone:860-608-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health