Provider Demographics
NPI:1225261118
Name:GLAROS, JACKIE (MSED,PC-CR)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:GLAROS
Suffix:
Gender:F
Credentials:MSED,PC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2345
Mailing Address - Country:US
Mailing Address - Phone:330-856-6663
Mailing Address - Fax:330-856-1581
Practice Address - Street 1:8577 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2345
Practice Address - Country:US
Practice Address - Phone:330-856-6663
Practice Address - Fax:330-856-1581
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP051616101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health