Provider Demographics
NPI:1568564268
Name:GLATZER, ANDREW (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GLATZER
Suffix:
Gender:M
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-7230
Mailing Address - Country:US
Mailing Address - Phone:201-313-3838
Mailing Address - Fax:201-313-3838
Practice Address - Street 1:880 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-7230
Practice Address - Country:US
Practice Address - Phone:201-313-3838
Practice Address - Fax:201-313-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001284001041C0700X
NYR031131-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ602467Medicare ID - Type Unspecified