Provider Demographics
NPI:1346880283
Name:GLAZER-ROSOFF, KERA ELISE (PHD)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:ELISE
Last Name:GLAZER-ROSOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KERA
Other - Middle Name:ELISE
Other - Last Name:GLAZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8215
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8215
Mailing Address - Country:US
Mailing Address - Phone:818-835-5012
Mailing Address - Fax:818-225-8896
Practice Address - Street 1:23564 CALABASAS RD STE 208
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1339
Practice Address - Country:US
Practice Address - Phone:818-835-5012
Practice Address - Fax:818-225-8896
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical