Provider Demographics
NPI:1336326982
Name:GLASSMAN, DAVID BRUCE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MONUMENT ROAD
Mailing Address - Street 2:BELMONT CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131
Mailing Address - Country:US
Mailing Address - Phone:215-581-9142
Mailing Address - Fax:215-581-3827
Practice Address - Street 1:4200 MONUMENT ROAD
Practice Address - Street 2:BELMONT CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131
Practice Address - Country:US
Practice Address - Phone:215-581-9142
Practice Address - Fax:215-581-3827
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008748L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling