Provider Demographics
NPI:1275684193
Name:GLICKMAN, ALISSA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:R
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BARCLAY CENTER
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-669-9122
Mailing Address - Fax:866-563-5311
Practice Address - Street 1:80 BARCLAY CT
Practice Address - Street 2:SUITE 4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-669-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0131911Medicaid