Provider Demographics
NPI:1275930919
Name:GLASSMAN NEUROPSYCHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:GLASSMAN NEUROPSYCHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-444-9811
Mailing Address - Street 1:2448 S 102ND ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2466
Mailing Address - Country:US
Mailing Address - Phone:414-444-9811
Mailing Address - Fax:414-444-9822
Practice Address - Street 1:2448 S 102ND ST
Practice Address - Street 2:SUITE 270
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2466
Practice Address - Country:US
Practice Address - Phone:414-444-9811
Practice Address - Fax:414-444-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1653-57103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty