Provider Demographics
NPI:1568417541
Name:HEATH, GLENN H (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:H
Last Name:HEATH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 MARKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1923
Mailing Address - Country:US
Mailing Address - Phone:215-679-5998
Mailing Address - Fax:
Practice Address - Street 1:1509 MARKLEY RD
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1923
Practice Address - Country:US
Practice Address - Phone:215-565-5876
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001094L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030642Medicare ID - Type UnspecifiedOUTPATIENT
PAR05688Medicare UPIN