Provider Demographics
NPI:1942597166
Name:GLICKMAN, PHILIP ADRIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ADRIAN
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BOERUM PL
Mailing Address - Street 2:6G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7713
Mailing Address - Country:US
Mailing Address - Phone:914-671-4860
Mailing Address - Fax:
Practice Address - Street 1:140 BROADWAY # 4657
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1108
Practice Address - Country:US
Practice Address - Phone:646-961-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY021281103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist