Provider Demographics
NPI:1275755126
Name:GLICKMAN, GARY ARTHUR (MFT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ARTHUR
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 17TH ST.
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-9040
Mailing Address - Country:US
Mailing Address - Phone:310-588-1172
Mailing Address - Fax:310-450-2465
Practice Address - Street 1:3331 OCEAN PARK BLVD
Practice Address - Street 2:#201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:320-588-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACCA42298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist