Provider Demographics
NPI:1154652667
Name:SKOLER, GLEN DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:DAVID
Last Name:SKOLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W PLUMSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1308
Mailing Address - Country:US
Mailing Address - Phone:240-605-2988
Mailing Address - Fax:484-461-9371
Practice Address - Street 1:250 W PLUMSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1308
Practice Address - Country:US
Practice Address - Phone:240-605-2988
Practice Address - Fax:484-461-9371
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPS030034103TC0700X, 103TF0200X
MD02989103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic