Provider Demographics
NPI:1376696872
Name:GLASER, ELISSA R (MA, PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:R
Last Name:GLASER
Suffix:
Gender:F
Credentials:MA, PSYD
Other - Prefix:DR
Other - First Name:ELISSA
Other - Middle Name:R
Other - Last Name:GLASER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, PSYD
Mailing Address - Street 1:14102 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1618
Mailing Address - Country:US
Mailing Address - Phone:773-263-7877
Mailing Address - Fax:
Practice Address - Street 1:887 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1309
Practice Address - Country:US
Practice Address - Phone:718-778-0485
Practice Address - Fax:718-778-1375
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNONE103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical