Provider Demographics
NPI:1518038561
Name:GLASSER, NEDRA Z
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:Z
Last Name:GLASSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MARINE VIEW AVE
Mailing Address - Street 2:#101
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2122
Mailing Address - Country:US
Mailing Address - Phone:858-755-7884
Mailing Address - Fax:858-350-8760
Practice Address - Street 1:140 MARINE VIEW AVE
Practice Address - Street 2:#101
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2122
Practice Address - Country:US
Practice Address - Phone:858-755-7884
Practice Address - Fax:858-350-8760
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPP0091120Medicaid
CAPP0091120Medicaid