Provider Demographics
NPI:1194819367
Name:GLOVINSKY, MARVIN ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ALAN
Last Name:GLOVINSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:A
Other - Last Name:GLOVINSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1919 S JONES BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0905
Mailing Address - Country:US
Mailing Address - Phone:702-362-7785
Mailing Address - Fax:702-362-4791
Practice Address - Street 1:1919 S JONES BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0905
Practice Address - Country:US
Practice Address - Phone:702-362-7785
Practice Address - Fax:702-362-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1059792501103T00000X
NVPY0026103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS11232Medicare UPIN
NVV106471Medicare PIN