Provider Demographics
NPI:1497838403
Name:GLAZER, ERNEST (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:GLAZER
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 1:1224 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1614
Mailing Address - Country:US
Mailing Address - Phone:215-659-9199
Mailing Address - Fax:215-830-8432
Practice Address - Street 1:1120 EASTON RD
Practice Address - Street 2:THE CENTER FOR FAMILY DEVELOPMENT -SUITE ONE
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1922
Practice Address - Country:US
Practice Address - Phone:215-830-8430
Practice Address - Fax:215-830-8432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0140591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW014059OtherLICENSED CLINICAL SOCIAL
PA07724577Medicaid
PAGL633742Medicare ID - Type UnspecifiedSOCIAL WORKER