Provider Demographics
NPI:1396832762
Name:MRGICH, GLENN A (BA CASAC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:MRGICH
Suffix:
Gender:M
Credentials:BA CASAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:PO BOX 631
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1912
Practice Address - Country:US
Practice Address - Phone:716-583-8503
Practice Address - Fax:716-882-0293
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-09-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-6198498Medicare UPIN