Provider Demographics
NPI:1740408202
Name:GLAT, MARK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GLAT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WITHERSPOON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-3207
Mailing Address - Country:US
Mailing Address - Phone:609-924-2225
Mailing Address - Fax:
Practice Address - Street 1:33 WITHERSPOON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-3207
Practice Address - Country:US
Practice Address - Phone:609-924-2225
Practice Address - Fax:973-584-9954
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ53647Medicare ID - Type UnspecifiedPSYCHOLOGIST