Provider Demographics
NPI:1346679966
Name:SLOMAN, GLENN (PHD, BCBA-D, NSCP)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SLOMAN
Suffix:
Gender:M
Credentials:PHD, BCBA-D, NSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIALTO PL STE 718
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3002
Mailing Address - Country:US
Mailing Address - Phone:321-345-0579
Mailing Address - Fax:321-360-7416
Practice Address - Street 1:100 RIALTO PL STE 718
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3002
Practice Address - Country:US
Practice Address - Phone:321-345-0579
Practice Address - Fax:321-360-7416
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
FLPY10127103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst