Provider Demographics
NPI:1629433321
Name:GLANTZ, ELAINE
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAYA
Other - Middle Name:
Other - Last Name:GLANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATR-BC
Mailing Address - Street 1:6023 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4814
Mailing Address - Country:US
Mailing Address - Phone:718-686-3400
Mailing Address - Fax:718-686-4400
Practice Address - Street 1:6023 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4814
Practice Address - Country:US
Practice Address - Phone:718-686-3400
Practice Address - Fax:718-686-4400
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP95902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional