Provider Demographics
NPI:1417119447
Name:INSABELLA, GLENDA M (PHD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:INSABELLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GLENDESSA
Other - Middle Name:M
Other - Last Name:INSABELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:86 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3647
Mailing Address - Country:US
Mailing Address - Phone:908-273-5558
Mailing Address - Fax:908-273-3355
Practice Address - Street 1:86 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3647
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:908-273-3355
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical