Provider Demographics
NPI:1376320259
Name:GLENMAR PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:GLENMAR PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-497-3369
Mailing Address - Street 1:162 S RANCHO SANTA FE RD STE F50
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6334
Mailing Address - Country:US
Mailing Address - Phone:415-497-3369
Mailing Address - Fax:
Practice Address - Street 1:162 S RANCHO SANTA FE RD STE F50
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-6334
Practice Address - Country:US
Practice Address - Phone:415-497-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty