Provider Demographics
NPI:1790074839
Name:GLICKMAN, PATRICIA M (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:GLICKMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:
Other - Last Name:GLICKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:625 SUITE B 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-5503
Mailing Address - Country:US
Mailing Address - Phone:805-610-8729
Mailing Address - Fax:805-876-5412
Practice Address - Street 1:625 14TH ST STE B
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7213
Practice Address - Country:US
Practice Address - Phone:805-610-8729
Practice Address - Fax:805-876-5412
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist