Provider Demographics
NPI:1821257726
Name:GLAUDE, ERIC G (LCSW CASAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:G
Last Name:GLAUDE
Suffix:
Gender:M
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W 132ND ST
Mailing Address - Street 2:SUITE 15-P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3202
Mailing Address - Country:US
Mailing Address - Phone:212-690-2688
Mailing Address - Fax:212-426-8273
Practice Address - Street 1:368 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3019
Practice Address - Country:US
Practice Address - Phone:917-399-9248
Practice Address - Fax:212-426-8273
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3874101YA0400X
NYR03780311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)