Provider Demographics
NPI:1275957094
Name:GLANTZ, MICHELLE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:B
Last Name:GLANTZ
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 1:13450 BAYLISS RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1833
Mailing Address - Country:US
Mailing Address - Phone:917-655-2363
Mailing Address - Fax:
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 711
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6605
Practice Address - Country:US
Practice Address - Phone:917-655-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020281103TC0700X
CA26110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical