Provider Demographics
NPI:1659852721
Name:GLICK, BETH SNIDER (LICSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:SNIDER
Last Name:GLICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PHILIP RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6022
Mailing Address - Country:US
Mailing Address - Phone:781-861-2500
Mailing Address - Fax:781-861-2615
Practice Address - Street 1:9 PHILIP RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6022
Practice Address - Country:US
Practice Address - Phone:781-861-2500
Practice Address - Fax:781-861-2615
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021715101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1021715Medicaid