Provider Demographics
NPI:1326113721
Name:GLICK, HILLARY (PHD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:GLICK
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 1:717 HALSEY ST
Mailing Address - Street 2:LOWR LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1206
Mailing Address - Country:US
Mailing Address - Phone:212-875-7454
Mailing Address - Fax:
Practice Address - Street 1:717 HALSEY ST
Practice Address - Street 2:LOWR LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1206
Practice Address - Country:US
Practice Address - Phone:917-589-0016
Practice Address - Fax:516-977-3266
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011217103TC0700X, 103TP0814X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097092Medicaid
NYV6A191Medicare ID - Type Unspecified