Provider Demographics
NPI:1275543746
Name:GLICKSMAN, STEVEN J
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:GLICKSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WEST END AV
Mailing Address - Street 2:#17K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-532-0387
Mailing Address - Fax:212-532-0387
Practice Address - Street 1:444 PARK AV S
Practice Address - Street 2:#603
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-532-0387
Practice Address - Fax:212-532-0387
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008913103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V29362Medicare ID - Type Unspecified