Provider Demographics
NPI:1689649550
Name:GLINTZ, BERNIE MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BERNIE
Middle Name:MICHAEL
Last Name:GLINTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TENNIS PL
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5164
Mailing Address - Country:US
Mailing Address - Phone:718-575-3328
Mailing Address - Fax:718-575-3328
Practice Address - Street 1:12 TENNIS PL
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5164
Practice Address - Country:US
Practice Address - Phone:718-575-3328
Practice Address - Fax:718-575-3328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR015298-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0089914Medicare ID - Type Unspecified