Provider Demographics
NPI:1821442757
Name:GLICK, GRETCHEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:GLICK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3467
Mailing Address - Country:US
Mailing Address - Phone:301-740-7807
Mailing Address - Fax:301-740-7809
Practice Address - Street 1:8810 POSTOAK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-3553
Practice Address - Country:US
Practice Address - Phone:301-986-3760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157341041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool