Provider Demographics
NPI:1578766184
Name:ROBERT H. GLASS, PH.D. PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT H. GLASS, PH.D. PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-449-9548
Mailing Address - Street 1:462 S MARENGO AVE
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3129
Mailing Address - Country:US
Mailing Address - Phone:626-449-9548
Mailing Address - Fax:
Practice Address - Street 1:462 S MARENGO AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3129
Practice Address - Country:US
Practice Address - Phone:626-449-9548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13687103TA0700X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13687Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST