Provider Demographics
NPI:1437133568
Name:GLICK, STANLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:GLICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-8003
Mailing Address - Country:US
Mailing Address - Phone:215-321-1435
Mailing Address - Fax:215-369-8258
Practice Address - Street 1:412 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8003
Practice Address - Country:US
Practice Address - Phone:215-321-1435
Practice Address - Fax:215-369-8258
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000778L1041C0700X
NJ44SC000789001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA189153Medicare PIN
NJ673114Medicare PIN