Provider Demographics
NPI:1417224791
Name:ROBERT S. GLAZER, PH.D., P.A.
Entity Type:Organization
Organization Name:ROBERT S. GLAZER, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:386-462-5155
Mailing Address - Street 1:19802 OLD BELLAMY RD
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-3867
Mailing Address - Country:US
Mailing Address - Phone:386-462-5155
Mailing Address - Fax:386-462-1952
Practice Address - Street 1:19802 OLD BELLAMY RD
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-3867
Practice Address - Country:US
Practice Address - Phone:386-462-5155
Practice Address - Fax:386-462-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty