Provider Demographics
NPI:1255509725
Name:GLICK, NICOLE P (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:P
Last Name:GLICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 MYRTLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3732
Mailing Address - Country:US
Mailing Address - Phone:410-446-5380
Mailing Address - Fax:410-484-2703
Practice Address - Street 1:2045 MYRTLEWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3732
Practice Address - Country:US
Practice Address - Phone:410-446-5380
Practice Address - Fax:410-484-2703
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical