Provider Demographics
NPI:1891797163
Name:GLASER, GEORGE P (MSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:P
Last Name:GLASER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 SHADY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1819
Mailing Address - Country:US
Mailing Address - Phone:512-371-9418
Mailing Address - Fax:512-637-8889
Practice Address - Street 1:11005 SHADY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1819
Practice Address - Country:US
Practice Address - Phone:512-371-9418
Practice Address - Fax:512-637-8889
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00319 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063867801Medicaid
TX54112070OtherBLUE CROSS BLUE SHIELD OF TEXAS