Provider Demographics
NPI:1811596455
Name:GLAZER, JILLIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:GLAZER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 E PASSYUNK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6385
Mailing Address - Country:US
Mailing Address - Phone:215-206-1547
Mailing Address - Fax:
Practice Address - Street 1:1005 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1202
Practice Address - Country:US
Practice Address - Phone:484-685-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0213901041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty