Provider Demographics
NPI:1326184532
Name:LEDERMAN GLAZER, ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LEDERMAN GLAZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NORTH AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2411
Mailing Address - Country:US
Mailing Address - Phone:718-358-8288
Mailing Address - Fax:718-358-5265
Practice Address - Street 1:14015B SANFORD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2557
Practice Address - Country:US
Practice Address - Phone:718-358-8288
Practice Address - Fax:718-358-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR014402-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical