Provider Demographics
NPI:1922098433
Name:GLANTZ, DEBORAH (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SAVIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2329
Mailing Address - Country:US
Mailing Address - Phone:781-338-7250
Mailing Address - Fax:781-338-7245
Practice Address - Street 1:178 SAVIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2329
Practice Address - Country:US
Practice Address - Phone:781-338-7250
Practice Address - Fax:781-338-7245
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
MAP08439OtherBLUE CROSS
MAP08439OtherBLUE CROSS